This chapter presents the findings of the review of theory. This section presents an overview of the causal map; Fear of crime: measures and contexts outlines debates around the definition and measurement of fear of crime and relates them to the map; Causal map: relationships explores in more detail the relationships between the different factors in the map; and Intervention pathways (logic model) presents a simplified logic model based on the causal map, setting out how interventions might have an impact on health and well-being outcomes. Figure 1 shows the overall causal map arising from the review of theory. The map shows six key concepts (the large hollow boxes) and a larger number of subconcepts (the smaller shaded boxes), together with the hypothesised relations between them. There are some areas where the key concepts overlap with each other. The map is broadly organised by scale, with individual (micro-level) factors nearer the top, meso-level factors in the centre and broad macro-level determinants nearer the bottom. In this section we summarise the six key concepts and provide definitions of the subconcepts; in the following section we consider some of the relationships that are important for the review. In principle, all types of crime are included in the theory review; however, three broad categories are likely to be especially relevant. For simplicity, only these are included as subconcepts in the model. Violent or potentially violent crimes against the person, such as rape, assault and mugging, are likely to cause substantial physical and/or psychosocial health harms for the victim and may often form the focus of fear. Drug- and alcohol-related crimes include a range of offences, such as violence, criminal damage, driving and public order offences, and crimes such as theft and burglary to fund drug habits; they often have a spatial patterning reflecting the locations of drug markets, alcohol outlets and the night-time economy. ‘Environmental’ crimes are those that impact directly on the quality of the physical environment, such as criminal damage, vandalism and graffiti; this category may also include non-criminal forms of antisocial behaviour such as littering. Of course, these are very different phenomena. In particular, the inclusion in the same concept of environmental crimes and serious violent crimes does not imply an endorsement of a punitive agenda towards the former. In general, the scope of this project precludes a fully critical perspective on the concept of crime and disorder. [Two further points should be added here on the definition of crime. First, some non-violent crimes against property, such as burglary and car theft, are also salient in that they may have substantial psychological and emotional impacts and be widely feared44 (on the distinction between crimes against the person and crimes against property relative to the fear of crime, see Chapter 3, Emotional response: further considerations). Second, given the environmental dimension of the review project as a whole, ‘domestic’ crimes such as child abuse and intimate partner violence will be less salient than ‘stranger’ crimes. This is in no way to minimise the extent or impact of domestic crimes, only to observe that they are of less relevance within the overall conceptual framework adopted for the review.] Fear of crime is a complex concept that raises a number of challenging definitional and methodological issues and is discussed further in Fear of crime; measures and contexts. The two most important subconcepts here are the individual’s perceived risk of being a victim of crime and his or her emotional responses to crime, such as worry or anxiety. The model also includes individual attitudes (e.g. beliefs about the nature and extent of crime) and perceived vulnerability to crime, as these are known to be closely bound up with fear. However, the perceived and actual rates of crime in the local area, and the individual’s objective risk of crime, are not included within the fear of crime concept, although they are linked to it. As discussed in Fear of crime; measures and contexts, it is difficult to draw a clear boundary around the concept of fear of crime, given its complex linkages with the social environment and individual psychology, and our definition represents a particular theoretical position that is not shared by all researchers in the field. Our perspective on health and well-being is comprehensive, including all forms of physical and mental health outcomes; health behaviours such as physical activity, and social well-being broadly conceived, including interpersonal interaction and social capital. As such, our concept of health and well-being overlaps substantially with the concept of the social environment (see Social environment). The built environment includes factors relating to the physical environment insofar as they are shaped by human activity. In particular, it includes the design of public spaces such as streets and parks, land use policy more generally (e.g. zoning regulations), public and private transportation and the architecture and design of residential housing. In the model, these are summarised with the subconcepts ‘housing’ and ‘public space and transport’. It also includes people’s interactions with the environment and the physical and geographical distribution of social factors. This category includes, for example, the sociodemographic make-up of communities, or social or legal restrictions on people’s movement within the built environment. In the model this is represented by the subconcept ‘neighbourhood and community factors’, which overlaps with the social environment. The subconcepts in the social environment cluster are based on a previous review of theory.45 ‘Neighbourhood and community factors’ are defined in the Built environment. ‘Social inequalities’ refers very broadly to the effects of sociodemographic factors such as socioeconomic status (SES), ethnicity and gender, including structural inequalities and individual discrimination. ‘Interpersonal relationships and networks’ includes more local-level dimensions of social interaction and can be taken to include measures such as social capital and social cohesion or integration. As such, it overlaps with the health and well-being concept, as we take the latter to include the social dimensions of well-being as well as individual physical and mental health. The role of national policies is not specified in detail in the model as a full discussion of their effects, particularly on health and well-being outcomes, lies outside the scope of this project. For our purposes, the main influences of interest are on the built environment and on crime. However, it is important to bear in mind that all of the other factors and relationships are shaped, more or less directly, by government policy, as well as by other macro-level determinants such as the economy. In this section we explore fear of crime in further depth. Fear of crime receives particular attention here for two reasons. First, there are complex relationships between the subconcepts that may be relevant for understanding the evidence and specifying the scope of the project. Second, there has been considerable debate about the concept’s meaning and coherence, and about the appropriateness and interpretation of the measures used. In discussing the findings of the fear of crime literature in the following sections, we have not always been able to give detailed attention to these issues, so this section serves as an overall guide to interpretation. This section is itself limited in scope: we do not engage with the full body of evidence on the determinants of fear of crime, only those that are of relevance to the model. In addition, we cannot here engage with the broader context of the debates around fear of crime research, particularly its political role, although the highly politicised nature of many apparently technical debates should be borne in mind.46–50 Some of these issues are addressed further in the following sections. Because of its extent and the ongoing contestation of fundamental issues, it is difficult to give a clear and uncontroversial overview of the field of fear of crime research. One basic distinction might be between, first, an older tradition, going back to the 1960s, which has been based on a broadly positivist, data-driven model of research, and which has focused on using observational research to explore the determinants of fear; and, second, a newer critical tradition, drawing on psychology and symbolic interactionist sociology, and strongly influenced by feminist thought, to understand fear as expressive of a broad range of attitudes and anxieties, and as rooted in the day-to-day reality of individual lives. Broadly, the two research paradigms have tended to correspond to a methodological divide, with the older positivist tradition emphasising quantitative survey measures and the newer critical tradition emphasising qualitative and ethnographic research. Only relatively recently, particularly with the work of Stephen Farrall, Jonathan Jackson and colleagues,49,51 has a viewpoint that draws together these two perspectives, and which utilises both qualitative and quantitative methods, emerged. Within the first, more data-driven tradition, four main theories, in the sense of perspectives emphasising particular causal factors, can be distinguished in the literature.52–56 Different authors divide up the theoretical field differently (e.g. some would include sociodemographic factors as a theoretical perspective in its own right), but these four are the main theories identified in the literature. The first is vulnerability theory, which emphasises the role of vulnerability to crime (defined further in Perceived vulnerability) in producing fear of crime and focuses particularly on explaining differences in fear between sociodemographic groups. The second is social disorder theory or social disorganisation theory, a more ecological approach that emphasises the role of local physical and social environments in engendering fear. The third is victimisation theory, which sees fear of crime as primarily driven by actual crime victimisation, and holds that it can be explained by the same factors as crime itself. The fourth is social integration theory, which emphasises the role of strong social networks and attachments at a local level as protective factors that may reduce fear. Researchers with a more synthetic perspective have seen these theories as reducing in turn to two paradigms, a rationalist and a symbolic paradigm.57 A rationalist view of fear of crime would see it as based primarily on approximately correct estimates of the risks and potential consequences of victimisation, whereas a symbolic view would see fear as bound up with the social meanings and representations of crime and disorder. However, this division does not line up perfectly with the theories described above. Victimisation theory is clearly rationalist; vulnerability theory is rationalist to some extent, but may need to appeal to symbolic accounts in explaining how estimates of the consequences of crime spill over into assessments of risk. Social disorder and social integration theories are usually expressed in symbolic terms, but they may have a strongly rationalist component in that disorder and low social integration may be causally linked to crime and function as roughly accurate indicators of actual risk (see Social environment and crime). As discussed further below (see Chapter 3, Perceived risk and emotional responses), teasing apart the rational and symbolic, or cognitive and affective, components of people’s behaviour may frequently be difficult, particularly in the context of secondary research. More generally, some researchers in the critical tradition have questioned the construct of ‘rationality’ in this context, arguing that judgements of rationality or (implicitly) irrationality are difficult to justify with reference to fear58 and that the dichotomy is in any case a blunt instrument in understanding the place and meaning of fear of crime in individuals’ lives and social relationships.59,60 In terms of our model, each theory can be seen to emphasise a different set of factors in terms of the strength of the hypothesised links to fear of crime outcomes. Accordingly, further information on the empirical grounding of each theory is divided between the relevant sections of the report. Vulnerability is discussed further in Perceived vulnerability; social disorganisation and social integration theories focus on the links between the social and physical environments and the fear of crime and are examined primarily in the section on these links (see Built environment, social environment and fear of crime); and victimisation, likewise, is examined in terms of the link between crime and fear of crime (see Crime and fear of crime). However, before examining these links, it is necessary to clarify what exactly is being measured in fear of crime research. The unclarity in this central question has often been remarked on in the literature. Ferraro and LaGrange61 reviewed the measures used in fear of crime research, finding that many heterogeneous and not directly comparable measures had been used and that many measures were inadequately validated. Although considerable methodological work has been carried out since, the points that they make are still substantially valid today.49,55 Studies that describe themselves as measuring ‘fear of crime’ may measure perceived risk of crime, perceived crime rate, feelings of safety, general anxiety or episodes of worry about crime (and many particular measures are possible for each type of outcome). This makes it challenging to interpret the findings of these studies, as apparently subtle differences or ambiguities in the measures used may have a substantial and unpredictable impact on the findings. In addition, even when the measures themselves are valid, the responses may be subject to bias. For example, social desirability bias relating to gender roles has been argued to account for almost all of the observed gender difference in affective fear outcomes.62,63 The immediate context in which questions are asked, such as the time of day, may have an impact on responses.64 Because of these problems, some researchers have concluded that the concept of fear of crime, as used in these studies, is largely an artefact of the methods used to measure it, and that it does not correspond to a meaningful social reality.65 Other researchers have argued further that the confusion is not purely adventitious but reflects the fact that fear of crime is an inherently vague and inclusive phenomenon that acts as an attractor for a wide range of ill-defined worries66 or for a general ‘urban unease’ engendered by the density and loose social controls of urban environments.67 The critical tradition in fear of crime research has developed this latter point further, exploring how fear of crime may embody and express broader attitudes towards social change and diversity, politics and policy, and ‘security’ in a deeper sense than statistically low risk.49,59,68–73 This work has emphasised the social construction of crime, risk and fear and argued that these high-level concepts may obscure the diversity and complexity of individual experiences of fear. It has also highlighted the way in which discourse about fear of crime in research and policy has functioned to perpetuate social hierarchies, by treating crime and fear in an uncritical fashion which occludes the social inequalities that underlie fear, especially the prevalence of male violence against women,70,71 and the question of whose interests inform the accepted definitions of fear.72 Much of this theoretical work is rooted in detailed qualitative research, the findings of which cannot be engaged with in detail here; the more detailed findings are discussed in Chapters 6 and 7, to the extent that they overlap with our reviews of empirical data. In the context of this chapter, four theoretical points are particularly relevant. First, fear of crime is not a free-floating social phenomenon (as both abstract causal modelling and the more positivist tradition of research sometimes imply), but makes sense only when situated in particular physical locations, and in individuals’ lives and personal concerns.68,70 Perceptions of space and the physical environment at a local level may interact with the broader determinants of fear in complex and unpredictable ways.70 Second, this research suggests that some of the links hypothesised by the model between fear and other factors, such as the environment or individual attitudes, may be better thought of as expressive relations between social meanings than as cause–effect relations between really distinct factors (see also Chapter 2, Models and theories in evidence synthesis). In particular, the simplistic dichotomy between ‘subjective’ fear and ‘objective’ crime rates may obscure the social dynamics underlying both phenomena. Third, as suggested earlier, the impacts of fear of crime are highly unequally distributed, and these inequalities tend to closely shadow the existing power relationships within society. The experience of fear of crime as a pervasive factor in one’s day-to-day existence is one that disproportionately affects women, ethnic minorities and people living in material disadvantage. For many people, fear of crime may refer as much to the latent violence that is implicit in discriminatory social structures as to the manifest violence that is measured by crime statistics; the inescapability of such fear, and its symbolic resonance with the marginalisation and devaluation of oppressed groups, may amplify its effect on mental health and well-being. Some scholars have utilised the concept of ‘spirit injury’ to encapsulate this link between individual victimisation and structural inequality.74,75 Fourth, this literature provides a holistic sense of how fear of crime may act as a window into high-level social structures and dynamics, by acting as an illustration of how individuals’ deep psychological need for security is played out at the social level. Ulrich Beck’s76 thesis of the ‘risk society’, which suggests that risk is the central trope of contemporary societies, that the nature of risk transcends quantitative estimations of likelihood and that people tend to seek individual solutions for social or trans-social risks, has been a productive theoretical reference point for some of this work.68 A somewhat different approach is represented by the work of Taylor and Jamieson,66,77 who see the fear of crime as a symbolic nexus that expresses concerns about national as well as personal status. We cannot here engage in any depth with these sociological theories, but one important potential implication is that the vague and inclusive nature of fear of crime may be as much a strength as a weakness, as it may enable researchers to grasp a complex domain of social and psychological reality with a single measure.49,78 In any case, it is clear that any attempt to synthesise the findings on fear of crime, and draw them into a more inclusive theory, will need to carefully distinguish the subconcepts that make it up and the different measures that may be used to investigate fear. Our model includes four subconcepts: perceived risk, or the individual’s estimate of how likely he or she is to become a victim of crime; emotional responses, including the whole range of affective reactions to crime or the threat of crime; perceived vulnerability and individual attitudes. These subconcepts and their inter-relations are examined briefly in the remainder of this section. The research linking fear to the other factors included in the model is covered in Causal map: relationships. In our model, the central axis of fear of crime is made up of the two subconcepts of perceived risk and emotional response, or one’s estimation of the likelihood of victimisation and one’s feelings of anxiety or worry about crime, which can broadly be described as the cognitive and affective components of fear respectively.79 [The action-oriented or ‘conative’ component, which some researchers include as a third dimension,55,79 is regarded as a separate concept (‘avoidance behaviours’) in our model.] The relation between them is complex. They may not always be closely linked: it is possible to know that one’s risk of crime is high without being emotionally concerned, or conversely to be highly worried while estimating the risk as low. At the same time, there may not always be a clear subjective separation between the two for individuals. Studies that have directly compared perceived risk and the emotional dimensions of fear have been inconsistent in their findings, but have generally found that they are never perfectly, and rarely very strongly, correlated;80–85 these findings are reviewed by Chadee et al.85 The strength of the association between perceived risk and emotional responses has been found to vary substantially depending on demographic variables such as gender and on the specific crime types investigated.81,83,86 Perceived risk and emotion have not always been clearly separated in the research. Given the weak correlation between them, this means that interpreting the findings of such research may be problematic. For example, questions such as ‘Do you feel safe in your area at night?’, which have been used in many fear of crime studies, could be interpreted as referring either to one’s affective ‘feelings’ of safety or danger or to one’s estimate whether one actually is safe.61 In addition, even if risk and emotion could be cleanly separated (as, for example, in Ferraro’s87 risk interpretation model), there are numerous potential indirect links, as shown in the model: emotional responses may be driven by a number of factors that also influence perceptions of risk (e.g. perceptions of the environment) but in different ways. A further complication (which is not explicitly included in the model) is that, as well as individuals’ own risk, the perceived risk of others, particularly partners or children, may have an impact on fear and behaviour. This ‘altruistic’ or ‘vicarious’ worry appears to be widespread.88,89 Given the inconsistency of the findings on perceived risk and affective fear, it is difficult to isolate factors that may help to explain the relationship. One complex of factors that may be relevant concerns the social and moral meanings of crime. Jackson et al.42 observe that, unlike other negative outcomes that may be feared, crime represents a deliberate attack on social norms and the social order. The ‘how dare they’ factor involved in affective reactions to crime, then, may complicate the link to perceived risk. This may explain why other harms that have a negative impact and which have been found to form the focus of fear more often than crime, such as illness, accidental injury or unemployment,90,91 do not appear to have the same affective valence, because their social meanings are different. (However, Jackson et al.42 do not explore the broader social meanings of ‘the “how dare they” factor’, for example in relation to social inequalities; see the discussion of ‘spirit injury’ in Background.) A related point is that anticipatory emotional responses, such as those involved in fear of crime, tend to relate to a repertoire of mental imagery more than to a detailed analysis of risk.47,55 This may drive the tendency noted earlier for fear of crime to act as a point of articulation for broader social concerns. Some researchers have argued on this basis for much more complex multidimensional quantitative instruments to capture fear, although this proposal has not been widely taken up.55 Apart from the basic distinction between perceived risk and emotional response, a number of further refinements have been suggested regarding the measurement of the latter. The first is the temporal dimension of fear, particularly the distinction between ongoing ‘dispositional’ fear and ‘transitory’ or episodic fear. The second is the distinction between normal, reasonable fear and fear that is excessive or pathological. The third, which also bears on perceived risk, has to do with the specific types of crime that are feared. Psychological research on fear and anxiety distinguishes ‘state’ anxiety, which is episodic in nature and responsive to particular situations, from ‘trait’ anxiety, which is a relatively stable and ongoing property of individuals.92 State and trait anxiety are generally conceived in this research as intraindividual tendencies and, as such, have been found to be not strongly correlated with fear of crime.93 More broadly, however, the distinction can be usefully adapted in the fear of crime context to distinguish ongoing ‘dispositional’ anxiety about crime and ‘transitory’ fear of crime, which is experienced as a discrete event.79 These distinct constructs can then be accessed using general, non-time-specific measures of anxiety (e.g. ‘How much are you afraid of . . .’) and measures that ask about the frequency of worry in a given time period respectively. Several empirical studies show that measures of frequency give substantially different results from generic measures.49,55,94–96 Using measures of frequency tends to lead to substantially lower estimates of fear, that is, a large number of respondents say that they are anxious in general, but report no or very few specific instances of worry. In addition, the two types of measure appear to be influenced by different factors, suggesting that two distinct constructs are in play. In particular, frequency of worry has been found to be fairly well predicted by perceived risk.60 It has been further argued that transitory fear tends to occur in response to particular situations, particularly the immediate threat of victimisation, whereas dispositional fear is driven by broader factors beyond the particular situation. Some researchers have seen this as a way to distinguish ‘formless’ or ‘expressive’ anxiety from ‘concrete’ or ‘experiential’ fear,49,65,95,96 and thus to isolate that component of expressed fear of crime which is responsive to actual crime, rather than to broader social attitudes and concerns. The argument in these papers is highly sophisticated and draws on a wide range of evidence and cannot be adequately discussed here; briefly, however, one might question whether time-specific fears necessarily correspond to concrete threats (rather than, for example, to expressive concerns about particular places or people encountered) and non-time-specific fears correspond to broad expressive factors (rather than, for example, to concrete but ongoing indicators of high crime levels). In addition, as noted earlier (see Background), researchers in the critical tradition might argue that latent structural violence – such as that involved in maintaining gender or ethnic inequalities – is as important as manifest violence in explaining fear of crime and should not be dismissed as merely ‘expressive’. The second clarification is to distinguish normal or ‘functional’ fear, which acts as a cue to behave in an appropriately cautious manner (e.g. by locking doors), from excessive or ‘pathological’ fear, which generates anxiety sufficient to lower one’s quality of life and which is not assuaged by routine precautions.97,98 (It should be noted that this is not the same as the distinction between ‘rational’ and ‘irrational’ fear, as the focus is on the effects of fear rather than its relation to objectively measured crime.) The distinction is important, as normal or functional fear may well not be problematic or especially negative, contrary to the presumption in much research and policy discourse that all fear of crime is a problem per se. Many people who report worry about crime also report that this worry has no effect on their quality of life.98 Across the population as a whole, 64% of respondents to the British Crime Survey report that fear has a low impact on their quality of life, 31% report that it has a moderate impact and 5% report that it has a high impact, although the proportion reporting a high impact is considerably higher for some groups in the population.91 The third point regards what specific types of crime are feared. Many studies have used generic measures such as ‘Is there any area near where you live, that is, within a mile, where you would be afraid to walk alone at night?’99 Other researchers have criticised the lack of specificity of such questions and have preferred to use measures that can explore the differences between different crimes. For example, the British Crime Survey100 uses a multiple measure of worry that includes worry about the following crimes: burglary from the home; mugging, car theft; theft from the car; rape; physical attack by strangers; being insulted or pestered and being attacked because of skin colour, ethnic origin or religion. Again, like the time-specific measures discussed above, crime-specific measures have received some attention as a means to distinguish realistic fears driven by crime risk from more formless expressive anxieties. However, as discussed in Crime and fear of crime, there appears to be relatively little reason to think that such measures do reflect more accurate judgements of risk. There is also a debate in the literature about how many different crimes need to be measured to obtain an accurate picture of fear of crime. Some studies using multiple measures have found that fear of different crimes can largely be reduced to, first, fear of crimes involving physical harm and, second, fear of crimes involving loss of property.101 Others argue that certain crimes, particularly rape and sexual assault for women, may be particularly salient in terms of fear and create a ‘shadow’ effect across fear of crime in general.102 It is clear that crime-specific measures cannot be straightforwardly regarded as accessing different parts or aspects of fear of crime. Some findings show that substantially greater numbers of people report worry about specific crimes than report feeling unsafe in general.103 In addition, decisions about which types of crime to investigate with respect to fear often depend on previous methodological decisions (often linked to broader sociological or criminological perspectives). The question of what counts as ‘crime’ is highly important for the interpretation of fear55 but has received limited attention, particularly in more data-driven quantitative research. In particular, most of the fear of crime literature has tended to focus on crimes committed by strangers in public places. The fear of violent crime in private spaces, committed by known offenders or intimate partners, has not been a salient theme in most fear of crime research, although research indicates that it is widespread and serious.70,104 One general point that emerges from this literature is that the effort to distinguish realistic from expressive fear of crime on the basis of more precise quantitative measures, and thus resolve the ‘risk–fear paradox’, has had limited success overall, although research on this point is ongoing. Moreover, the critical tradition provides cogent reasons to think that the distinction itself may be based on a misconception (see Chapter 7, Fear and rationality). In terms of the model, it might be hypothesised that, if a sharp distinction were shown to be tenable, this would lead to stronger links between crime and realistic fear on the one hand, and expressive fear and health and well-being outcomes on the other, but a less coherent model overall, in the sense that realistic and expressive fear would themselves represent two substantially distinct phenomena. The resolution of the risk–fear paradox would thus tend to block any attempt to see fear as linking crime and well-being outcomes at a community level. However, the considerations in this section suggest that the paradox has not been satisfactorily resolved. If so, there may be more scope to see risk and crime as linked to well-being outcomes in a holistic way, even if the evidence for the individual links is frequently ambiguous. We return in Fear of crime and health and well-being to the question of how different measures of fear relate to health and well-being outcomes. To anticipate, the distinction between cognitive and affective measures may, tentatively, be reflected in the research findings, which appear to suggest that emotional responses have a greater impact on health and well-being than perceived risk; this is intuitively plausible and is reflected in the model by the more direct connections of the former to health and well-being. Both dispositional and episodic measures of fear have been found to be associated with health outcomes. However, the other distinctions explored here do not seem to have been explored with regard to their health and well-being impacts. Intuitively, it might be expected that pathological fear is more damaging than normal fear, and fear of serious violent crimes more damaging than fear of less serious crimes and crimes against property. Further research would be valuable here. Vulnerability has been seen as encompassing three concepts: risk, perceived negative consequences of crime and perceived control.60,105 For our purposes, the concept of risk is not included in vulnerability, as it has its own subconcept in the model; vulnerability can then be seen as the combination of an individual’s perceptions of the severity of the consequences of crime and his or her ability to exert control, that is, to defend him- or herself against attack. These factors may relate to an individual’s ability to defend him- or herself physically, to the social resources on which one can draw to counteract crime, or to situational factors such as the presence of other people who may be able to assist.105,106 Vulnerability has been of interest particularly in explaining inequalities in the social distribution of fear.103 That is, it may help to explain why certain groups, particularly women, older people and socioeconomically disadvantaged groups, have a greater fear of crime but less objective risk of victimisation; their fear is a response to their greater vulnerability and the greater impact that crime has when it does occur. However, assessing the value of vulnerability in explaining these differences is challenging. Many studies have not sought to measure vulnerability directly but have used demographic variables directly as proxies for vulnerability.56,103 However, when self-rated vulnerability has been measured, it has been found to be a better predictor of fear than age, gender or disability.107 The effects of perceived consequences and control have been found to be substantially less important than those of perceived risk, which is not a dimension of vulnerability by our definition.60 In addition, some of the findings on demographic differences in fear have been questioned. As noted earlier, some researchers have questioned whether differences between men and women may not be an artefact of the measures used;62,63 others have found that the purported difference between older and younger people tends to disappear, or even reverse, when the questions focus on fear of specific crimes.87,108,109 As a result, although it remains true that vulnerability is associated with fear of crime and has a role in explaining the genesis of fear for individuals, its value in explaining the social distribution of fear remains open to debate. For our purposes, the most important insight of vulnerability theory is that factors other than perceived risk may have a substantial impact on fear, and hence reducing risk may have a limited impact on fear. The model also includes an ‘individual attitudes’ subconcept. To some extent, this serves to capture the broader expressive factors outlined earlier, relating, for example, to the social meanings of crime as they impact on individual judgements and emotional responses. More specifically, a range of attitudes may be relevant in explaining the fear of crime, including perceptions of police effectiveness or attitudes to policing110 and broader political and social attitudes, such as those regarding law and order or social change.111 Again, as with vulnerability, attitudes are included in the model primarily to indicate the halo of factors that may impact on individuals’ fear, and as a reminder that the central drivers in the model do not fully account for fear of crime outcomes. The map attempts to show the linkages between both the main concepts and the subconcepts. In some cases links are shown in detail, whereas in others they are more schematic. For example, the influence of individual demographics on health and well-being outcomes is not broken down according to the different outcomes of interest. In addition, not all potential pathways are shown, only those that are of interest for the review. In this section we summarise the theoretical bases of some of the key relationships and a selection of the relevant empirical evidence. Crime may impact on health in a range of ways,112 which can broadly be grouped into two categories, namely direct and indirect impacts.113 Direct impacts include physical injuries caused by violent crimes against the person and the psychological trauma that may accompany crimes involving violence or the threat of violence, or crimes such as burglary that involve intrusions into the private sphere. In the model, this is represented by the link from violent crime to physical and mental health. Indirect impacts include a wide range of negative effects that crime can have at a community level, for example by exacerbating social problems that impact on health. This distinction corresponds roughly to that between an individual perspective on crime and health and a social perspective. The individual perspective, which focuses on the direct impacts of victimisation on individuals, has been the primary focus of the literature on crime and health.113–115 These physical and mental health impacts on victims are often substantial and long-lasting.116,117 ‘Domestic’ crimes, including child abuse and intimate partner violence, may have particularly serious health impacts.118–120 However, at a community level, the health impacts are likely to be less substantial, because serious violent crime is relatively rare. In 2010–11 there were approximately 2.2 million incidents of violent crime in England and Wales,121 representing approximately 42 incidents per 1000 people per year. Dolan et al.122 estimate the total health loss from the direct physical and psychological impacts of violent crime as being equivalent to 0.0024 quality-adjusted life-years (QALYs) per person per year. However, this may be an underestimate as it includes costs relating to victims only rather than also including those relating to witnesses or victims’ families or friends, and the figures on which it is based may underestimate certain types of crime, particularly domestic crimes. In addition, crime and the health burdens of crime are highly unequally distributed, so the health impact is likely to be substantially higher than the average for some subgroups of the population. The community- or social-level perspective on crime and health presents a more complex picture. Violent crime has been found to be associated with a wide range of negative health status outcomes at a neighbourhood level, including all-cause mortality,123 coronary heart disease124 and preterm birth and low birthweight,125 as well as health behaviour outcomes such as lower levels of physical activity.126,127 Exposure to community violence is also known to be associated with negative physical and psychological health, particularly for children and young people.128,129 However, although these associations are well established, the causal pathways involved remain open to debate in many cases. Taking a social perspective on crime and health also demands a theoretical shift, analogous to that from the individual perspective of clinical medicine to the population perspective of public health and epidemiology. Perry130 argues that approaches to the prevention of violent crime still have much to learn from public health more generally, in that approaches known to be valuable within public health have not been widely applied to questions of crime. In particular, violence prevention has tended to focus on ‘high-risk’ subgroups in the population, rather than shifting the mean of the population as a whole, and on secondary rather than primary prevention. Taking a public health-informed approach to crime would imply de-emphasising questions of why specific individuals engage in criminal activities in favour of asking why crime rates and types vary across populations and areas. Perry also argues, drawing on Farmer,131 that it would imply a greater focus on the ‘structural’ violence latent in unequal and unjust social orders, not only on the manifest violence measured by crime statistics. This point relates to the idea of ‘spirit injury’ discussed earlier (see Background), and suggests that a population-based approach to crime and health will need to take into account the indirect as well as the direct impacts of crime, and to engage critically with the concept of crime itself. As already discussed, such a population-level approach has been widely adopted in the observational epidemiological literature on crime and health. However, it has generally not informed the development of intervention strategies. Winett’s132 review on violence in the USA as a public health problem found that, although authors tended to identify social and structural causes for violence, the interventions that they proposed targeted individual behaviour change and improved public health practice and de-emphasised social factors. Winett’s132 findings suggest a need for a more contextually informed understanding of crime and health and of the potential for interventions to ameliorate the health impacts of crime. A further body of research has examined the links between alcohol availability or use and violence. These links may be complex: alcohol consumption may increase risky behaviour, inhibit the ability to avoid violence, increase the risk of being a victim of violence and increase the risk of violent tendencies developing in those exposed to alcohol in utero.133 A summary of the epidemiological and criminological literature134 notes that, although problem drinking is associated with intergenerational transmission of intimate partner violence and of violence perpetration and victimisation for both men and women, and is significantly related to violent offending, the causal link between alcohol consumption and violent behaviour remains questionable. (Throughout this report, when an association or finding is referred to as significant, we mean ‘statistically significant’ unless otherwise stated.) However, the author notes that the economic literature does suggest a causal link through studies examining price changes and alcohol outlet density. This potential link is of particular interest for our purposes. Two systematic reviews of studies examining the effects of changes in alcohol outlet density have found a positive association between alcohol outlet density and increased alcohol consumption and related harms, including injuries and violence.135,136 The causal direction of the link between high outlet density areas and alcohol consumption rates is unclear,136 although outcome evaluations of interventions do exist in addition to observational studies. Finally, as well as the pathways from crime to health described above, there may also be pathways in the other direction, insofar as people with health problems, particularly serious mental health problems, may be at greater risk of crime;137–139 this is represented in the model by the pathway from mental health to crime. The link between crime and fear of crime is conceptually obvious but empirically complex. Until recently a long-standing truism of fear-of-crime research was that objective risk of crime was poorly correlated with perceived risk and affective fear outcomes. Victimisation theories of fear of crime posit that fear is largely driven by the lived experience of victimisation. However, this theory does not appear to be strongly supported by the data. Although research does tend to show some relationship between victimisation experience and fear, it is not as strong as might be expected.140–142 However, this may depend on the measures used. Some researchers have found that victimisation is associated with frequency of worry, as opposed to dispositional measures.49 Repeated or multiple victimisation may also be more strongly associated with fear than one-off or occasional victimisation,117 although it is less clear that it has more severe mental health impacts. At a broader level, it is unclear to what extent individuals’ perceptions of their own risk represent accurate estimates of the probability of victimisation (as measured by area-level crime rates or individual-level predictors of risk), or are responsive to changes in the latter. Some studies have found that most individuals are ‘pessimists’ in that their estimated risk of crime is substantially higher than their actual measured risk.143 However, other studies with a more specific focus have found the opposite result; for example, women’s estimations of the risk of sexual assault have been found to be relatively ‘optimistic’.144 Such results have led some researchers to speak of a ‘risk–fear paradox’.145,146 Empirical studies of the correlation between risk and fear tend to show that there is a relation between the two, but that it is not very strong. Most studies do find that there is a statistically significant relationship, but also that it explains only a small amount of the variation in fear. Again, there is considerable controversy about which measures of fear best access the relationship. For example, some researchers hypothesise that measures which access worry about specific crimes (as, for example, the British Crime Survey measure) may be more closely related to objectively measured crime rates than those that access anxiety about crime in general. However, there does not appear to be any trend towards a stronger relationship with objective risk in studies that use the former type of measure of fear147,148 than in studies using more global measures of anxiety.149–151 The conclusion would seem to be that the strong formulation of the ‘risk–fear paradox’, which states that there is no relationship at all, should be rejected, but that in a weaker form – namely, that the primary explanation of fear, however defined, must be sought elsewhere than in objective risk – the paradox is borne out by the observational quantitative data. Without reviewing these data systematically and dealing in depth with the methodological issues, this conclusion cannot be fully secure; nonetheless, it seems probable (see Chapter 7, Fear and rationality). The question that then arises is which other factors may explain variation in fear, given the relatively limited importance of objective victimisation risk. One type of explanation that has received considerable attention is the various factors that may affect individuals’ estimations of risk. In the model, this is shown, first, by the cognitive heuristics and biases that influence individuals’ judgement of crime rates and of their own risk of being victimised in relation to actual (objectively measured) crime rates and risk; and, second, by the various other factors, including the perceived social and physical environment, social and media representations of crime, and interpersonal relationships, that influence fear outcomes. As we use it here, the distinction between objective and subjective risk refers simply to two types of measure. We are neutral with regard to the epistemological debate over whether divergences between them should be understood as subjective distortions and misunderstandings of an objective reality, or whether they constitute two equally valid, but potentially incompatible, ways of constructing reality. The role of environmental factors is discussed in Built environment, social environment and fear of crime; here, we focus on the role of social and media representations and risk heuristics. Media representations and reporting of crime have often been put forward as a source of people’s understanding of crime and risk. However, the empirical data on media consumption and fear of crime are equivocal: although some studies support a link,152 others do not.153,154 Some theorists have argued that the media do not act alone in influencing individuals’ perceptions, but in association with a repertoire of social knowledge, perceptions and imagery that derives from others’ experiences and perceptions of crime and disorder; in addition, as briefly noted earlier, these perceptions relate to people’s broader views about politics and social change.145,155 Hence, these perceptions may also be influenced by individuals’ structural position within a community and their relationship to it,70,73,155 and by the wider structures of socioeconomic, political and cultural relations within society.78,103,156 The role of the media and social representations, therefore, inter-relates with that of national policy and social inequalities, as well as with local-level features of individuals’ social networks and environments. The notion of cognitive heuristics is drawn from psychological research on individual decision-making under conditions of risk and uncertainty. This research derives from the classic work of Tversky and Kahneman157 who define three commonly used heuristics: representativeness, availability, and anchoring and adjustment. Representativeness is when people judge the probability of a hypothesis (e.g. related to our focus here, ‘I may be a victim of crime’) by considering how much the situation resembles available data (previous experience, media and social representations). Availability is when individuals estimate the frequency of an event (criminal acts), or a proportion within a population (‘who commits crimes’), based on how easily an example can be brought to mind. Anchoring and adjustment is the tendency for people to base their assessments or judgements about risk on one piece of information or ‘anchor’.158 In crime research, anchoring and adjustment can be seen at work in people’s answers to crime surveys, with perceptions of how the rates of particular crimes have altered differing between common crimes, in which the anchor tends to be personal experience, and serious violent crime, in which the anchor is more likely to be national media coverage.159 These heuristics are likely to create substantial divergence between actual and perceived risk of crime (and may possibly account for the potential for intensive policing interventions to increase fear by raising awareness of crime160). A further dimension in the perception of risk, which is not explicitly represented in the model, is that the social and psychological levels are not independent but may be mutually reinforcing. That is, these cognitive heuristics may act not only on an individual level but also on a social level, particularly in the choices made by mass media about when and how to report crime news.47 Theoretical frameworks such as the social amplification of risk theory161 emphasise the role of differential communication patterns in constructing the social meanings of risk. Media representations draw on people’s everyday concerns and create feedback loops connecting them to the social and political discourses around crime, as well as policy and practice, hence ‘amplifying’ these concerns at a social level. The theorising of links explaining the relations between the built environment and crime, and to inform the development of interventions, goes back to the 1960s. These theoretical approaches have focused on identifying features of the built and social environment that provide opportunities for or encourage criminal acts, which may be then adjusted to reduce or discourage criminality.162 These theories, which include ‘defensible space’ and ‘broken windows’ theories,43 as well as the ‘space syntax’ approach developed by Hillier et al.,163,164 are perhaps best summarised in terms of Crime Prevention through Environmental Design or CPTED.162,165,166 It should be noted that, although the ‘broken windows’ theory is of clear relevance to this review, its application in policing practice has tended to emphasise more traditional approaches, with an emphasis on increasing prosecutions for minor crimes (also known as ‘zero tolerance’ policing) and on reducing ‘social disorder’ such as public drinking, with the built environment a relatively minor theme.167,168 As such, ‘broken windows’ policing is tangential to our concerns here. ‘Design’ in the CPTED paradigm covers a wide range of permanent and semi-permanent physical and social environment features at different levels, from individual houses to whole neighbourhoods. Also important are physical features resulting from human activity, which fall into one of two clusters: signs of lack of caring or incivilities (litter, graffiti, vandalism, abandoned buildings, vacant lots) or signs of investment and involvement.169 CPTED includes a range of strategies that focus on territoriality, surveillance, access control, activity support, image management and target hardening.170 CPTED approaches emphasise the creation of environments that foster a strong sense of ‘ownership’ or ‘territoriality’, as this improves the chances for natural surveillance (‘eyes on the street’). Such surveillance reduces the likelihood of potential offenders committing crimes as they perceive a greater chance of being ‘caught in the act’, and is further strengthened by designing in formal surveillance measures (CCTV, security patrols, Neighbourhood Watch). Controlling access to areas aims to reduce access to potential targets for crime, thereby creating an increased sense of risk in potential offenders. A further aspect of this is target hardening, which aims to increase the efforts that offenders make in carrying out crimes by restricting access through the use of physical barriers, such as fences, gates, locks, alarms and lighting, and security patrols. In contrast, activity support includes using design features to encourage specific patterns of usage of public space. This may be to locate ‘unsafe’ activities (e.g. monetary transactions) in ‘safe’ areas (e.g. those with good surveillance) or to encourage natural surveillance opportunities through mixed usage of public spaces and the numbers of ‘eyes on the street’. Avoiding the neglect of public spaces and routine maintenance sustains a positive image of places/spaces and thus avoids them becoming ‘magnets’ for criminal activity.170 CPTED approaches have been taken up in larger-scale policy initiatives such as Secured by Design,171 which recommends the integration of crime prevention into the design and planning process. This approach to crime prevention views much criminality as being the result of situational opportunities, that is, that the built or social environment provides (or fails to restrict) opportunities for individuals to commit crimes. The theoretical underpinnings of this view rely heavily on classical rational choice theory, which posits that criminal behaviour (like all behaviour) results from rational, self-interested action that maximises individual utility. Thus, criminal activity occurs when the individual perceives that the potential benefits outweigh the potential costs (punishment, social stigma). This approach also draws on two further theories. Routine activity theory suggests that crime occurs when there is a temporal and spatial intersection of a motivated offender, an attractive target and a lack of capable guardianship. The theory of social disorganisation suggests that, within disorganised communities, or communities lacking in collective efficacy, the breakdown of informal social controls facilitates the emergence of criminal cultures. One potential weakness of CPTED approaches is the potential for crime to be displaced to an adjoining area, another time, other targets, by other means or a different type of crime – the emphasis on securing a particular space or physical area from crime leads to the spatial displacement of crime to another area nearby.170 Thus, evaluation of the effectiveness of CPTED in reducing crime or fear of crime needs to include analysis of any displacement effects of the initiatives. The approach has also been criticised for focusing on public outdoor spaces to the neglect of private indoor or domestic spaces, which may be the sites of serious abuse.172 Similar criticisms can be levelled at the focus on fear-of-crime theories and practices that assume private or domestic spaces to be places of safety. Another criticism is the potential of CPTED approaches to produce a ‘bunker mentality’, leading to reduced social cohesion or withdrawal of certain parts of the community behind the lines of defensible space;170 more broadly, CPTED has been critiqued as an aspect of the privatisation and ‘securitisation’ of formerly public space, and the sanitisation of (what is perceived as) social disorder.173 The empirical evidence base for CPTED and related theories is mixed. Observational studies (reviewed by Schneider and Kitchen43) have found some links between crime and variables such as density, traffic volume and street connectivity. However, many are cross-sectional with inadequate controlling for confounders, and systematic research syntheses are lacking, so the reliability of this literature is limited (although the ‘space syntax’ theorists mentioned earlier have started to develop more sophisticated methodologies for investigating these questions). The literature on the effectiveness of interventions at the level of the built environment in reducing crime is considerably more robust, and several rigorous systematic reviews have been conducted. Welsh and Farrington174 find that CCTV is effective in reducing crime although, when disaggregated by setting, a significant effect was observed only for car parks and not for any other setting (public transport, public housing, city centres). Improved street lighting and neighbourhood watch schemes are effective in reducing crime.175,176 Multicomponent interventions using CPTED approaches are effective in reducing robberies in retail settings.177 There is little robust data on the effectiveness of CPTED-type approaches in residential or community settings, although some findings are promising.39 Finally, there is some evidence that Secured By Design approaches are associated with reduced property crime.178 The relation of these theories and empirical findings to the further outcomes that we are interested in – health, well-being and fear of crime – is unclear. Few studies have sought to directly evaluate the health or well-being benefits that may accrue to the population from successful crime reduction interventions. Fear of crime outcomes are discussed in Built environment, social environment and fear of crime; the theories discussed above have tended to see the reduction of crime and fear of crime as going hand in hand, although it is unclear to what extent this is empirically supported (we return to CPTED theory in Chapter 7, Crime Prevention through Environmental Design). A comprehensive overview of theories of crime causation and the social environment, and relevant empirical data, is beyond the scope of this study. In particular, the relations between social inequalities and crime cannot be explored here. However, one theoretical perspective that is relevant centres on the idea of ‘collective efficacy’. This perspective emphasises the influence of the social environment on rates of crime and criminal motivation. Collective efficacy, defined as the level of social cohesion (based on informal social controls) within a neighbourhood or community, along with the willingness of its members to intervene on behalf of the (perceived) common good, has been suggested as a means to explain differences in crime rates, including homicide, between neighbourhoods with similar aggregate demographic characteristics.179 Collective efficacy is embedded in the structural and cultural characteristics of a neighbourhood, which either support or undermine the density of social ties of kinship, friendship and familiarity and the levels of participation in collective action.179 The original theorists focused on informal social controls of the activities of children and young people, although more recent work has examined the role of collective efficacy in intimate partner violence and homicide.180 The idea of collective efficacy also underpins community development approaches to crime reduction, within which residents are supported to establish their own organisations to address issues within the community, including crime and fear of crime.181–183 Rather than specific actions designed to influence individual criminal behaviour, this approach ‘is a framework for action which establishes the necessary preconditions through which individual criminal motivation or behaviour can be changed through routine practice’ (p. 422).181 Thus, the focus is on relationship building within the community, the development of institutional, structural and economic assets, collective engagement and actions and sustainable institutionalised change.181 It should be noted that the theory that collective efficacy protects against crime has been subject to critique, on the basis that certain forms of social connectedness and collective action may in fact serve to condone and perpetuate certain kinds of crime, for example by providing social capital to offenders within criminal subcultures, or by promoting norms of inequality that provide social legitimation for crimes such as intimate partner violence.184,185 As with many of the other links examined in this review, then, the relation between the social environment and crime is not straightforward, and quantitative variables describing social structures may be either positively or negatively associated with crime, depending on the precise measures used, the types of crime considered and the broader social context. Broader social factors may also have an impact on crime. For example, socioeconomic inequality has been found to be associated with violent crime at a national level.186,187 However, space precludes any detailed discussion of such broader links. The model presents the built and social environments as each acting independently on both perceived crime rates and perceived individual risk, to reflect the fact that these environmental variables may act ‘globally’ on crime and perceptions of crime, or locally on perceived individual risk (e.g. particular people or locations encountered in one’s daily routine that are perceived as dangerous). These local variables and pathways may be very specific in nature and the model does not distinguish the specific factors that may be involved. This section covers the built and social environment together because the main theoretical paradigms have tended to treat both as aspects of the same underlying issue. The pathways linking the environment to fear of crime have often been seen as closely related to those linking the environment to crime (examined in Built environment and crime and Social environment and crime). The pathways in the case of fear may be somewhat more challenging to investigate. Environmental factors may affect fear not only cognitively, by affecting people’s perceptions of crime rates or individual risk, but also by directly affecting their emotional responses to their environment and exacerbating feelings of threat or anxiety, which may be expressed as fear of crime. In addition, as noted above, some researchers argue that fear of crime is a nebulous concept that may often reflect broader dissatisfaction with the physical and/or social environment. Hence, in some cases, it may be more appropriate to think of the perceived environment as a dimension of fear in its own right, rather than as distinct from and causally linked to fear. Among the theories of fear of crime discussed earlier (see Fear of crime: measures and contexts), social disorder theory most clearly focuses on the role of environmental factors. The central concept here is that of ‘incivilities’ or ‘disorder’, which encompasses both problems in the built environment, such as vandalism and abandoned properties, and problems in the social environment, such as people dealing or using drugs. The most usual form of this theory is symbolic rather than rationalist, in Elchardus et al.’s57 terms. That is, ‘disorder’ in the form of problems in the built or social environment may play the role of a symbolic indicator of social problems, economic deprivation or political neglect, and hence increase fear independently of its effect on actual crime. Other theories posit both broader symbolic influences from the environment on fear of crime, and factors that may act rationalistically on fear by increasing actual crime risk. The former include social integration theory, which emphasises the role of local-level social networks (a dimension of the social environment in our model) in increasing fear and may be linked to the collective efficacy theory of crime (see Social environment and crime), which suggests that weak social integration and collective norms tend to exacerbate crime. However, researchers have hypothesised both positive and negative associations between social integration and fear. Some suggest that social support or social capital may act as a buffer and help to lessen fear of crime; others suggest that higher social interaction may increase fear of crime by increasing communication regarding crime and heightening the perception of risk.188 The latter include the theories examined earlier linking certain features of the built environment, and weak social integration or collective norms, to crime (see Built environment and crime and Social environment and crime respectively), which suggest that environmental problems may form part of a complex of causal factors that increase crime. Social disorder theories in their narrow form appear to be borne out by the observational data, which show a consistent association between perceived social and physical disorder and perceived risk or fear of crime.149,189–194 The association of perceived disorder with affective measures of fear has been found to be weaker than its association with perceived risk,84,190 although other findings indicate that the link between the physical environment and fear of crime persists even when perceived risk is controlled for.149 Perceived disorder has also been found to correlate more strongly with fear of property crime than with fear of personal crime; this has been hypothesised to relate to the more ‘patterned and predictable’ nature of the former.190 These findings suggest that disorder impacts on fear primarily as an indicator of crime risk. However, other research indicates that individuals’ perceptions of social and physical disorder are a better predictor of their fear than objectively assessed measures of these problems;195,196 in the model, the environment is separated from the perceived environment to reflect this distinction. This finding may relate to the point made earlier about expressive and causal links. That is, it suggests that the observed association between disorder and fear may result less from individuals using disorder as an indicator of risk than from the fact that the perception of environmental conditions is already laden with social attitudes and judgements,197 such that the observed relation between perceived disorder and fear is more an expressive linkage between two nexuses of social meaning than a cause–effect relationship.198 (This type of link may also be expressed as a correlation between the perceived built environment and the perceived social environment, directly or through broader constructs such as ‘neighbourhood attachment’.199) Theories that posit a broader role for the environment are less clearly supported by the empirical data. Regarding the built environment, some research has found larger residential buildings to be associated with fear of crime while being more weakly associated with actual crime rates; this has been linked to ‘defensible space’ theories discussed in Built environment and crime.200 However, other studies have not found an association between building size and fear.201 With regard to the broader urban environment, green space has been found to be associated with better perceived safety, although this is less true in dense urban areas.202 Non-residential land use has been found to be associated with lower feelings of safety, although the association does not survive controlling for actual crime rates.203 It is also unclear to what extent the potential pathway from the built environment to fear of crime extends to the health and well-being consequences of the latter. One study finds that the association between perceived crime and mental health outcomes was increased by better residential environments.204 Regarding social integration or social cohesion, as measured, for example, by people’s perceptions of their relationships with their neighbours or their participation in community organisations, the literature does not suggest a relationship with fear in either direction. Some studies find a significant association between stronger social interaction or social cohesion, at least on some measures, and a lower fear of crime.194,205,206 However, many studies find no consistent association.52,207–212 It should be noted that these studies are heterogeneous in the measures used for both fear of crime and social integration, and a more detailed analysis might reveal a clearer pattern. Many of these studies also present more complex analyses looking at different environmental factors. For example, one study finds that social interaction may buffer the negative effects of the built environment on fear.210 Moreover, it is clear that there are correlations between the social environment and the built environment, although this linkage cannot be explored in detail here. Of particular interest are potential correlations between built environment factors, such as patterns of land use, and collective efficacy outcomes.213,214 Local-level factors such as area SES have also been found to be correlated with fear, although the pathways involved are not entirely clear.215 Moreover, national policies may have an effect on fear of crime. One study finds that more generous social welfare policies are associated with higher levels of perceived safety.78 The potential for interventions at the level of the built environment is discussed further in Intervention pathways (logic model). Interventions at the level of the social environment may include crime reduction interventions such as Neighbourhood Watch, as well as broader programmes to promote social integration and cohesion. Police-initiated programmes to engage and educate communities about crime and risk may also be seen as social environmental interventions. There is a substantial body of literature linking factors in the built environment to health and well-being outcomes, which can be only very briefly summarised here. The main theory has been environmental stress theory, which sees well-being as determined by the balance between stressors, such as noise, traffic, poor housing, overcrowding or the threat of crime, and countervailing protective factors, such as social integration.216,217 The causal interactions here may be complex, as some psychosocial protective factors may themselves be influenced by the environment. In addition, a number of longer pathways may operate: the pathways from the built environment to crime and fear of crime may join up with those that lead to health and well-being; and, similarly, the built environment may affect health through its impact on the social environment. These pathways are often hard to distinguish in practice, and also difficult to isolate from the impacts of socioeconomic disadvantage on individuals and communities. Many of the associations between the environmental stressors listed above and poorer mental health outcomes are well supported by robust empirical research.216,218 Several of these factors, particularly traffic and poor housing conditions, may also impact directly on physical health. There is some evidence that built environment interventions, particularly housing improvements, can have positive health impacts.219 The environmental stress concept is useful for our purposes because it forms a framework for thinking about crime and fear of crime as pathways between environmental determinants and health outcomes, and substantiates the general concept that poor environments can impact on health by increasing day-to-day stress and anxiety. Thus, crime has been investigated as part of a larger complex of environmental stressors.220 More specifically, three longer pathways may link the built environment, health and crime or fear of crime. First, what we have called ‘environmental crime’ has impacts on the built environment, although it is unlikely that these make a substantial contribution to the health impacts of the latter. Second, features in the built environment may also be linked to the social environment and social well-being in ways that are relevant to crime and fear of crime. Third, the built environment may make a difference to health behaviours, particularly outdoor physical activity. The perceived and actual qualities of the built environment, such as accessibility and aesthetic qualities, are known to be associated with physical activity;221,222 such perceptions may interact with the determinants of crime and fear of crime in the built environment. There are three types of potential pathway from fear of crime to health and well-being. First, the worry and anxiety induced by fear of crime (in the affective sense) may impact on mental health more broadly; in addition, the psychological distress involved in fear is a mental health outcome in its own right, hence the overlap in the model. In the other direction, poorer health may also exacerbate fear of crime and its health effects. Second, fear of crime may lead to avoidance behaviours such as limiting one’s movements outside the home, which may impact negatively on health behaviours such as physical activity and on social interaction. Third, fear of crime may impact on social well-being at a community level by decreasing social cohesion and increasing neglect, with consequent effects on residents’ well-being; it may further influence some the decision of some residents to move home, hence potentially changing neighbourhood composition in ways that may have community-level well-being impacts. The literature on fear of crime and health is relatively small but reasonably consistent, once the measures are disaggregated. Several studies have found that affective measures of fear of crime, worry about crime or feelings of unsafety are associated with poorer mental and physical health.208,223–228 The study by Jackson and Stafford229 is not included here because it focuses on the opposite causal pathway (see next paragraph) and because it uses the same fear of crime data as Stafford et al.227 Several outcomes have been found to be associated with fear, including self-reported general health,223,224,226 mental health,208,223,226–228 physical functioning,227 quality of life227 and a composite index of self-reported general health and physical functioning.225 There is also some evidence of an association between higher perceived crime, or lower perceived safety, and poorer health and well-being outcomes, although the findings here are more equivocal and complicated by the strong association of both types of outcome with SES;204,230 other studies have found no clear association.231,232 The main pathway accounting for the effects found in these studies appears to be the first listed above, namely the psychological distress created by fear of crime and the further effects of this distress. In addition, poor health, particularly mental health, may increase perceived vulnerability and hence fear of crime. The British Crime Survey91 found that 20% of those with bad or very bad health said that fear of crime had a high impact on their quality of life, compared with 5% across the population as a whole. Qualitative studies have also found that fear of crime tends to have particularly negative impacts on those with existing mental health problems.233 This indicates that, as well as the pathways from fear of crime to health outcomes, there are also pathways going in the opposite direction.229 The direction of causality is difficult to establish from the quantitative data alone, but there is reason to think that the reverse pathway – from poor health to fear – may be substantial. This should be borne in mind when assessing the theoretical possibility of improving well-being by reducing fear because, if much of the association between the two outcomes is explained by this reverse pathway, the impact of fear reduction on well-being may be limited. As noted earlier (see Emotional response: further considerations), many researchers have called for greater precision in the measurement of fear of crime, on several dimensions. With respect to the distinction between perceived risk and emotional responses, the findings cited earlier may suggest that the latter have a greater impact on health and well-being outcomes although, because of the non-systematic nature of this review, this finding should be regarded as indicative only. With respect to the distinction between dispositional fear and episodic fear, both have been found to be associated with health outcomes; of the studies cited earlier, five use non-time-specific measures208,224,226–228 and two measure frequency of worry.223,225 With regard to the distinction between functional and pathological fear, limited data are available on health outcomes, although this would be a promising avenue of investigation. Studies have elicited respondents’ perceptions of the impact of fear on quality of life91,98 and used this to make the distinction between functional and pathological fear, but we did not locate any studies that make the distinction independently and then measure the association with quality of life or other well-being outcomes. Potential differences in the health impacts of fear by type of crime have also, to our knowledge, not been investigated. The mental health impacts of fear of crime are probably relatively limited across the population as a whole. The utility loss has been estimated at 0.00065 of a QALY per person per year or around one-fifth of the mental health impacts of crime itself,122,234 although to our knowledge no modelling work has been carried out on the basis of more in-depth empirical studies such as that by Stafford et al.227 to provide more accurate estimates. The second pathway linking fear of crime to health outcomes is through the behaviours adopted to lessen the perceived risk of victimisation. This pathway may operate at a place-specific level: the percentage of respondents avoiding certain areas or neighbourhoods because of their concern about crime has been measured at 48% in a sample of the general US population99 (see Table 2.40) and 84% in a sample of women in the UK.88 However, it may also operate on a more global level, particularly for women, as constraints on behaviour resulting from fear become internalised and normalised as an attitude of constant vigilance235–237 that intersects with the broader dynamics of gender norms and the social control of women’s behaviour.70,88 These avoidance behaviours may be linked to health and well-being outcomes in two ways. First, avoidance behaviours may limit interpersonal interaction, leading to poorer mental health.227 Again, there may be a feedback loop here whereby limiting social interaction also increases fear in its turn.140 Second, concerns about neighbourhood safety may lead people to change their behaviour to limit outdoor physical activity, leading to poorer physical health. This pathway has received considerable attention in the theoretical literature.238 There is some evidence for an association between perceived safety and physical activity, although the findings in the literature are mixed.239,240 The association appears to depend substantially on demographic characteristics, with safety having a greater effect on physical activity for older people209 and women.209,241 Measures of affective fear are also associated with lower physical activity.223 The extent to which these pathways influence the further health consequences of lower physical activity is unclear. One study found that measures of avoidance behaviour (not going outdoors) because of fear are associated with several mental and physical health status outcomes in a sample of older people;242 interestingly, the associations are generally stronger for men than for women in this study. In addition, some findings suggest an association between lower perceived safety and obesity, although the effect is only borderline significant.243 In addition, as discussed below, physical activity appears to mediate at least some of the association between fear of crime and health outcomes. The third pathway hypothesises that fear of crime leads to decreased trust and cohesion within communities and to individual withdrawal, with a series of feedback loops at community and policy levels leading to progressive decline in the social and physical environments, with consequent well-being effects at a social level.55,188 In the model, this can be seen as the loop that goes from fear of crime to interpersonal relationships, and from there (as part of the social environment) directly and/or via the built environment to the perceived environment and back to fear of crime. However, although this pathway has received considerable theoretical attention, it is difficult to substantiate empirically because, as noted earlier (see Built environment, social environment and fear of crime), research findings on fear of crime and the social environment are not consistent and, even when a link is well established, the direction of causality is not clear. In particular, as actual environmental problems appear to predict fear considerably less well than perceived problems, the existence of strong feedback loops between fear and actual environmental change remains to be proven. The relative importance of the pathways is difficult to quantify. Ross223 investigates psychological distress and physical activity as mediators of the effects of fear on general health. Stafford et al.227 investigate physical activity and social interaction as mediators for mental and physical health outcomes. Both find that a substantial amount of the association is explained by these pathways, but not all. Possible measurement error aside, this may suggest a role for broader effects such as those hypothesised by the third pathway above, or it may reflect pathways from other variables not included in these studies. Figure 2 shows the logic model for interventions. The logic model was derived by simplifying the causal map, aggregating the key concepts (built environment; crime; fear of crime; social environment; health and well-being), disregarding some of the pathways linking these to each other and rearranging to focus attention on pathways that may be amenable to intervention. The main focus of interest regarding interventions is modifications to the built environment (box 1). However, such environmental interventions are frequently combined with other components, such as changes to policing practice or the criminal justice system (box 2), and community- or policy-level interventions to improve the social environment, for example by encouraging social cohesion (box 3). These form the intervention level of the logic model. The mechanisms through which these interventions may lead to improved health are specified in boxes 4–8. Very broadly, two main types of pathway can be distinguished. The first consists of interventions seeking to reduce crime (box 4). If successful, such interventions may reduce individuals’ fear of crime (box 6), with resulting positive impacts on psychosocial health and well-being (box 9). (Such interventions may also impact on health outcomes (boxes 8 and 9) by reducing the direct physical or mental health impacts of crime victimisation; these pathways are marked by dotted lines to distinguish them from the community-level impacts.) Interventions such as CCTV and street lighting and approaches based on CPTED are examples of this pathway. Two subpathways may also operate in some contexts. First, environmental interventions may seek to reduce fear of crime (box 6) directly by reducing the perceived risk of victimisation, for example by changing street layouts to remove hiding places for attackers; this may be beneficial whether or not the intervention reduces the actual crime rate. (Interventions such as CCTV may also have such an impact on fear, by acting as a visible deterrent, independently of their impact on crime.) Second, as many types of crime or antisocial behaviour (such as graffiti, vandalism and illegal dumping of rubbish) have a direct impact on the built environment, reducing rates of these crimes will improve the latter. The second pathway consists of interventions seeking to improve the social environment (box 5), hence improving residents’ relations with their environment and reducing fear of crime (box 6), as the latter is known to be strongly linked to the social environment. [Such interventions may also have impacts on psychosocial health (box 9) and/or health behaviours (box 7) that are unrelated to crime, although these lie outside the scope of the review; these pathways are marked with dashed lines in Figure 2.] Urban regeneration and housing improvement are examples of interventions on this pathway. Interventions that seek to increase social integration or social cohesion may also have the aim of reducing actual rates of crime. A further pathway that may coexist with either of the above two is that reducing fear (box 6) may improve health behaviours (box 7), particularly physical activity, hence leading to improved physical health (box 8). (The intervention model does not attempt to capture the links between physical health, psychosocial health and health behaviours.) |
What are the issues that develop when fear of crime is the driving force behind a criminal policy
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