• By Dartington SRU
  • Posted on Wednesday 16th September, 2009

Olds’s baby is branded “Obamacare”

Crime used to be the political issue in the United States. Twenty years ago crime rates were four times higher than they were in 1960 and the murder rate was off the scale. Fast forward to 2009: the growth in crime has been halted and it has slipped off the political top table as a result. An African American occupies the Oval Office and healthcare reform dominates the political agenda. Nevertheless, crime rates are still twice what they were when JFK took charge of the White House. Writing in the magazine Newsweek, Mark Kleiman, Professor of Public Policy at the University of California Los Angeles, argues that healthcare reform, which has usurped crime as the political plat du jour, “has the potential to reduce crime at very little cost”. Here he is referring to Nurse Family Partnership, developed by David Olds, professor of pediatrics at the University of Colorado. NFP is based on a straightforward concept: send nurses into the homes of poor and under-educated first time mothers to coach them through the first difficult years. Old's devised the intervention nearly 30 years ago and these days around 20,000 families across 29 US states are receiving it. Owing much to UK health visiting introduced in the 1940s, the original NFP objective was to lower rates of sickness, substance abuse and welfare dependency among mothers and children. Studies have proved that it works, making savings that amply cover its costs, says Kleiman. But the benefits have been shown to spread even wider and to have a significant impact on crime. By the time the children involved in the trials were 15, those who had been brought up with NFP were arrested less than half as often and convicted only one fifth as often, as other similar children. There are questions still to be answered about the scaling up of the program, Kleiman acknowledges, but there is little question that nurse home visits prevent crime and save money. But NFP has become a bone of contention rather than the measure of political consensus, due largely to the program’s place in Barack Obama’s healthcare bill.From a distance, it might appear that NFP would appeal across the political spectrum – with its life-affirming aims of helping mothers, strengthening families, reducing the burden on the state, not to mention the potential reductions in crime. True enough, it has received support from some prominent Republicans as well as the Democrats. However, caustic criticism has also been rife. Kleiman explains how it has been mocked with such sloganizing as “billions of babysitters”, “Obamacare’s home intrusion and indoctrination family services”, and even as a “stealth agenda to impose federally directed parenting”. “It’s a cliche that the only things the two parties in Washington can agree on supporting are motherhood and apple pie - but maybe they cannot even agree on motherhood anymore,” he concludes. Nurse Family Partnership is just one of the preventive interventions that Kleiman mentions in his new book When Brute Force Fails: How to have less crime and less punishment. As well as recommending an overhaul of justice and policing based on true cost-benefit estimates, he cites early intervention in the community as a key element of any crime control strategy. Kleiman laments the fact that policy change does not come more easily. “The first step in getting away from brute force is to care more about reducing crime than about punishing criminals, and to be willing to choose safety over vengeance when the two are in tension.”• Read more about a wide range of public policy issues on Mark Kleiman’s blog; to read more about the prevention science background to home visiting in the UK and US, see Show me the money and I’ll show you what worksSee: Kleiman M (2009), When Brute Force Fails: How to have less crime and less punishment, Princeton University PressKleiman M (2009), "How Health Care Reform Could Combat Crime", Newsweek, September 12, 2009

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