Larry Cohen, MSW Executive Director

1. We Know What To Do: Preventing Violence Creates Thriving Communities Boulder, CO October 8, 2013 Larry Cohen, MSW Executive Director @preventioninst http://www.facebook.com/PreventionInstitute.org

3. Child Restraint & Safety Belt Use

4. B E Y O N D Brochures

5. Health in all Policies: A Health Lens in Decision-making

6. “Simply put, in the absence of a radical shift towards prevention and public health, we will not be successful in containing medical costs or improving the health of the American people.” - President Obama

8. “No epidemic has ever been resolved by paying attention to the treatment of the affected individual.” - George W. Albee

9. A Public Health Approach to Violence • Population-based • Focuses on prevention • Reduces risks • Increases protective factors www.preventioninstitute.org/UNITY

10. What can be done to prevent the problem from occurring in the first place?

11. “We are still standing on the bank of the river, rescuing people who are drowning. We have not gone to the head of the river to keep them from falling in. That is the 21st century task.” Gloria Steinem MOVINGUPSTREAM Photo Credit: http://static.flickr.com/90/207590972_a30260c293_b.jpg

12. The Prevention Continuum Up Front In The Thick Aftermath Approaches that take place BEFORE violence has occurred to prevent initial perpetration or victimization Immediateresponses AFTERviolence has occurred to deal with the consequences in the short-term Long-termresponses AFTER violence to deal with the lasting consequences and treatment interventions

13. Violence Prevention in Public Transportation Washington, DC, USA Source: Wikipedia. http://en.wikipedia.org/wiki/File:Washington_DC_metro_station_bethesda.jpg

14. NORMS sanction behavior more than a habit based in culture & tradition attitudes, beliefs, ways of being taken for granted behavior shapers communicate regularity in behavior

16. “ The ideas of one generation become the instincts of the next. ” - D.H. Lawrence

17. BEHAVIOR BEHAVIOR ENVIRONMENT EXPOSURES HEALTH & SAFETY

18. Photo courtesy of Latino Health Access

19. Photo courtesy of Latino Health Access

20. “ It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and physical environment conspire against such change. ” Institute of Medicine Source: Institute of Medicine. (2000). Promoting health: Intervention strategies from social and behavioral research (B. D. Smedley & L. S. Syme, Eds.). Washington, DC: National Academies Press.

21. Poor people and people of color are more likely to live in neighborhoods receiving less public and private investment in infrastructure and consequently can appear disorganized and unsafe. Image Credit: Jelm6 Flickr • SOURCE: Williams DR, Collins C. (2001) Racial residential segregation: a fundamental cause of racial disparities in health. • Landrine H, Corral I. (2009) Separate and unequal: residential segregation and black health disparities Image Credit: Michelle Mockbee Flickr

22. Oakland, CA

23. a 15 year difference in life expectancy Source: Life and Death from Unnatural Causes – Health and Social Inequity in Alameda County.Alameda County Public Health Department. August 2008

24. For every $12,500 in family income:One additional year life expectancy

25. The health inequities we see…are not about just individual bad choices: “ ” they are about things not being fair Nancy Krieger, Harvard School of Public Health

27. EXPOSURES & BEHAVIORS ENVIRONMENT The Trajectory of Health Inequities HEALTH CARE SERVICES INJURIES, ILLNESS & INEQUITIES

28. Take 2Steps to Prevention Medical Care Exposures & Behaviors Environment

29. Medical Care Alone Cannot Reduce Injuries and Inequities • Not the primary determinant of health • Treats one person at a time • Often comes late; can’t always restore health

30. What’s Sold and How It’s Promoted

31. Elements of Community Health PLACE • What’s sold & how it’s promoted

32. Liquor Store Closings Los Angeles, CA • Zoning ordinances shut down 200 liquor stores in 3 years. • An average 27% reduction in crime within a four-block radius of each closed liquor outlet.

33. Elements of Community Health EQUITABLE OPPORTUNITY MEDICAL SERVICES • Preventative services • Access • Treatment quality, disease management, in-patient services, & alternative medicine • Cultural competence • Emergency response • Racial justice • Jobs & local ownership • Education PLACE • What’s sold & how it’s promoted • Look, feel & safety • Parks & open space • Getting around • Housing • Air, water, soil • Arts & culture PEOPLE • Social networks & trust • Participation & willingness to act for the common good • Acceptable behaviors & attitudes

34. Activity Taking 2 Steps To Prevention

35. The 1st step ... Environment Exposures & Behaviors Health Care Services

36. Two Steps To Prevention Activity List specific examples from your community of the community health factors you circled in column C. Choose up to 3 examples for each factor. Circle the Exposures/ Behaviors listed below that are related to your health issue. Circle the factors below that are related to your health issue. Type 2 Diabetes

37. Let’s take another step ... Environment Exposures & Behaviors Health Care Services

38. Two Steps To Prevention Activity List specific examples from your community of the community health factors you circled in column C. Choose up to 3 examples for each factor. Circle the Exposures/ Behaviors listed below that are related to your health issue. Circle the factors below that are related to your health issue. Type 2 Diabetes

39. Louisville, KY: Healthy Corner Stores Louisvilleky.gov

40. The Spectrum of Prevention Influencing Policy & Legislation Changing Organizational Practices Fostering Coalitions & Networks Educating Providers Promoting Community Education Strengthening Individual Knowledge & Skills

41. Elements of Community Health PLACE • Parks & open space

42. “. . .We could use this place as a place to play sports. We don’t get to interact as much because we don’t have places to play. The bond is broken. We could build a park so that kids my age can stay active healthy and connected.” Daisy Romero, Age 13 Photo Voice Project, Santa Ana, CA

43. Park Access Acres of Park Space per 1,000 people 31.8 1.7 0.6 Reference:Paul M. Sherer. “The Benefit of Parks.” Trust for Public Land, 2006.

44. Park Access Acres of Park Space per 1,000 people Predominantly White Neighborhoods 31.8 1.7 0.6 African American Neighborhoods Latino Neighborhoods Reference:Paul M. Sherer. “The Benefit of Parks.” Trust for Public Land, 2006.

45. Prospect Park: BeforeRevival Brooklyn, NY Image Credit: Librado Romero, The New York Times

46. Prospect Park Revival Brooklyn, NY Photo Credit: Librado Romero, The New York Times

47. UNITY City Network Members www.preventioninstitute.org/UNITY

48. UNITY City Network Seattle Minneapolis Boston Detroit Newark Richmond Chicago Philadelphia Cleveland Oakland Denver (San Jose) Louisville St. Louis Los Angeles Nashville San Diego Tucson Houston New Orleans www.preventioninstitute.org/UNITY

49. Coordinate the UNITY City Network Guide Effective & Sustainable Practice: Training, tools and consultation Make the Case: Framing the discourse on preventing violence Educate Decision Makers & Inform National Strategies: Highlighting what works, including supportive policies and resources UNITY Activities

50. UNITYAssessment Findings • Law enforcement and criminal justice the most common approaches • Public health departments rarely included • Most cities lacked a comprehensive strategy • Cities with the greatest coordination had the lowest rates of youth violence