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www.preventioninstitute.org
Larry Cohen, MSW
Executive Director
University of New Mexico
Tuesday, December 6th
, 2011
Making the Case and
Making It Work
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Why prevention?
Making the case for prevention
Tools to do prevention
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Oakland, CA
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Occupy Oakland
Photo courtesy of Nicole Schneider
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Golden Gate Bridge panorama
Hardly the most original shot - but it's not that often we get such great weather in SF to shoot the bridge, either. This is a panorama made from 3 shots shot vertical at ~70 mm.
Comments
Sanyuktaa says:
Beautiful, nice perspective Posted 29 months ago. ( )
smashpOppler says:
wow stitched panorama. good job Posted 29 months ago. ( )
Christopher Chan says:
Beautiful sunny shot ! I wonder if it is an optical illusion but the far pylon of the bridge looks like it is tilted. :)
--
Seen on netvibes.com (?) Posted 29 months ago. ( )
ShUtTeR PrO says:
Nice work
This Great Photographic Art was made by a Diamond Class Photographer!
Please add your photo to Flicker Diamond The Diamond Class Photographer
Read the group rules please and tag your photo DiamondClassPhotographer
You may tag your photo again as flickrdiamond Posted 29 months ago. ( )
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Born in West Oakland, an African-American
person can expect to die almost 15 years earlier
than a White person born in the Oakland Hills.
SOURCE: Life and Death from Unnatural Causes – Health and Social Inequity in Alameda County.
Alameda County Public Health Department. August 2008
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The health inequities we see…are not
about just individual bad choices:
Nancy Krieger, Harvard School of Public Health
“
” they are about things not being fair
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What’s Health Got
to Do With It?
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Photo courtesy of Latino Health Access
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Photo courtesy of Latino Health Access
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Photo courtesy of Latino Health Access
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Photo courtesy of http://spacedust.atspace.com/soccer_archery.html
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HEALTH & SAFETY
BEHAVIOR BEHAVIOR
ENVIRONMENT
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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
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The Trajectory of Health and Health Inequities
EXPOSURES & BEHAVIORS
HEALTH CARE SERVICES
ENVIRONMENT
A Key Opportunity
for Prevention
INJURIES, ILLNESS & INEQUITIES
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From Kools to Cancer Sticks
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Prevention
is the Prescription
QUALITY
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QUALITY
Prevention
is the Prescription
Comprehensive
Aimed at the community
environment
Changes norms:
Makes healthy options
the default
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a systematic process that reduces the frequency and/or
severity of illness or injury.
Promotes healthy environments and behaviors to prevent
problems from occurring before the onset of symptoms
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Building Community Momentum to
Improve Health and Equity
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Keep it Local
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Shut down 200 liquor stores in 3
years
Average 27% reduction in crime
within a four-block radius of
each closed liquor outlet
According to WHO: “Limitation
on the number and placement of
outlets will result in reductions
in alcohol-related problems.”
Use Real People and Stories
South Los Angeles, CA
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Connect policy, projected health
outcomes, and projected savings
For every $1
investment in trails
There was a $2.94
medical savings due
to the physical
activity levels of
trail users
Lincoln, NE
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http://preventioninstitute.org/component/jlibrary/article/id-75/127.html
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$1 Investment
SOURCE: Prevention for A Healthy America: Investments in Disease Prevention Yield Significant
Savings, Stronger Communities, Trust for America’s Health, July 2008
$5.60 (US)
$4.8 (CA)
Return on
Investment
Savings at
5 years
$16 Billion
Annual Savings
In 5 Years
($1.7 Billion CA)
Prevention for A Healthy America
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Community Partnership
Law Enforcement
Public Health
Violence Prevention
Healthy Eating Active Living
City Council
Youth
Include Co-Benefits
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Push the Envelope
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Take 2
Steps to
Prevention
Health Care
Services
Exposures & Behaviors
Environment
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Photo courtesy of http://tycohealth-ece.com/files/d0003/ty_rn33d7.jpg
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Causes of Death
Heart Disease
Cancer
Stroke
Diabetes
Injuries & Violence
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Not the primary determinant
of health
Treats one person at a time
Often comes late; can’t always
restore health
Medical Care Alone Cannot
Reduce Injuries and Inequities
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The 1st
step ...
Health Care
Services
Exposures & Behaviors
Environment
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Heart Disease
Cancer
Stroke
Type 2 Diabetes
Injuries
& Violence
Diet &
Activity
Patterns
Tobacco
Alcohol
& Drugs
Making Links to Exposures & Behaviors
SOURCE: McGinnis JM , Foege WH. Actual causes of death in the United States.
Journal of the American Medical Association. 1993; 270: 2207-2213.
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Let’s take
another
step ...
Health Care
Services
Exposures & Behaviors
Environment
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Root factors
Compromised
social & physical
environments
EXPOSURES &
BEHAVIORS
HEALTH INEQUITIES ENVIRONMENT
HEALTH CARE
SERVICES
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Addressing the Intersection:
Preventing Violence and Promoting Healthy Eating and Active
Living
Healthy
Eating &
Physical
Activity
Safety &
Preventing
Violence
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Preventing Violence through Urban Farming
Denver, CO
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Increasing Trails and Pathways
Driggs, Idaho
Passed city
ordinances to
integrate new
development with
existing trails
Working to create
a trail that
circumnavigates
Yellowstone and
Grand Teton
National Parks
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Preventing Violence and Increasing Literacy
Salinas, California
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Health Impact Analysis
Worthington, Minnesota The national Center for
Healthy Housing is evaluating
health outcomes of green
building design
Comparing health status of
occupants before, immediately
after housing rehabilitation
Results will inform local
zoning decisions and building
codes
SOURCE: http://www.nchh.org/Research/DC-
Green-Housing-Rehabilitation.aspx
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Health
Services
Prevention
Integrated Approach
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Community-Centered
Health Homes
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1. Improve health outcomes overall
2. Advance equity
3. Reduce health care demand and
costs
Shared Goals:
Community Prevention &
Health Care
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Community-Centered
Health Homes
Patient-Centered
Health Homes
Medical
Homes
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Transferable to Community Prevention
Existing Clinician Skills
PATIENT INTAKE
DIAGNOSIS TREATMENT
Capture and
identify
population
level health
trends
Analyze and
prioritize
relevant
community
conditions
Engage in
advocacy and
translate clinic
priorities into
action
INQUIRY ASSESSMENT ACTION
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Overarching Systems Change
Recommendations
Structure health care payment systems to support CCHHs
Leverage current opportunities for government, philanthropy, and community benefits to support CCHHs
Consistent metrics for evaluation and continuous quality improvement
Networks to support peer-to-peer learning
A cadre of health professionals prepared to work in CCHHs
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INQUIRY ASSESSMENT ACTION
ENVIRONMENTAL & POLICY CHANGE
COORDINATED CLINICAL & COMMUNITY PREVENTION
ACTIVITY
IDENTIFY PRIORITY
HEALTH ISSUES
COMPREHENSIVE STRATEGY
DEVELOPMENT
PARTNERSHIP
FORMATION
• Health Care
• Public Health
• Community Organizations
DATA
COLLECTION
CLINICAL/COMMUNITY
POPULATION HEALTH INTERVENTION MODEL
OUTCOMES
IMPROVED HEALTH
COST SAVINGS
EVIDENCE-BASE FOR EFFECTIVE
PRACTICE
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1.) Community Transformation Grants
2.) National Prevention Strategy
3.) Center for Medicare and Medicaid Innovation
Opportunities for Prevention
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Center for
Medicare & Medicaid Innovation
Patient Care Models
Seamless & Coordinated Care
Models
Community & Population Health
Models
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Center for
Medicare & Medicaid Innovation
Improved Quality of Care
Reduced Costs
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National Prevention Strategy
Strategic Directions
Image Credit: National Prevention Strategy,
June 16, 2011
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Agriculture
Housing and Urban
Development
Labor
Department of Defense
Health and Human
Services
Transportation
Education
Homeland Security
Office of Management
and Budget
Environmental Protection Agency
Veterans Administration
Federal Trade Commission
Drug Control Policy
Interior for Indian Affairs
Domestic Policy Council
Corporation for National and
Community Services
National Prevention, Health Promotion,
and Public Health Council
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Collaborator 4
Expertise /
Resources:
Anticipated
Outcomes:
Key Strategies:
Collaboration 3
Expertise /
Resources:
Anticipated
Outcomes:
Key Strategies:
Collaborator 1
Expertise /
Resources:
Anticipated
Outcomes:
Key Strategies:
Collaborator 2
Expertise /
Resources:
Anticipated
Outcomes:
Key Strategies:
Shared Outcomes
Partner Strengths
Joint Strategies/
Activities
Collaboration Multiplier
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Coalitions and Networks
Partnerships
Among
Systems
Health Justice
Education
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Push the Envelope
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Claiming Health
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Claiming Health
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Claiming Health
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Claiming Health
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We’re Not Buying It
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We Need All Our Voices
to Build a Movement
Photo Credit: http://www.historycooperative.org/journals/jah/91.4/images/hall_fig01b.jpg
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221 Oak Street
Oakland, CA 94607
Tel: (510) 444-7738
Sign up for our media alerts:
http://www.preventioninstitute.org/alerts
www.preventioninstitute.org
Follow us on:
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www.preventioninstitute.org
TOOLS
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Influencing Policy & Legislation
Changing Organizational Practices
Fostering Coalitions & Networks
Educating Providers
Promoting Community Education
The Spectrum of Prevention
Strengthening Individual Knowledge & Skills
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Developing Effective Coalitions:
The 8-Step Process
1. Analyze program objectives, determine whether
to form a coalition
2. Recruit the right people
3. Devise preliminary objectives and activities
4. Convene the coalition
5. Anticipate necessary resources
6. Develop a successful structure
7. Maintain coalition vitality
8. Improve through evaluation
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Links Between Violence and Health
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THRIVE
Tool for
Health and
Resilience
In Vulnerable
Environments
http://preventioninstitute.org/thrive/index.php
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