www.preventioninstitute.org

Larry Cohen, MSW

Executive Director

University of New Mexico

Tuesday, December 6th

, 2011

Making the Case and

Making It Work

Why prevention?

Making the case for prevention

Tools to do prevention

Oakland, CA

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

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

What’s Health Got

to Do With It?

Photo courtesy of Latino Health Access

Photo courtesy of Latino Health Access

Photo courtesy of Latino Health Access

Photo courtesy of http://spacedust.atspace.com/soccer_archery.html

HEALTH & SAFETY

BEHAVIOR BEHAVIOR

ENVIRONMENT

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

The Trajectory of Health and Health Inequities

EXPOSURES & BEHAVIORS

HEALTH CARE SERVICES

ENVIRONMENT

A Key Opportunity

for Prevention

INJURIES, ILLNESS & INEQUITIES

From Kools to Cancer Sticks

Prevention

is the Prescription

QUALITY

QUALITY

Prevention

is the Prescription

Comprehensive

Aimed at the community

environment

Changes norms:

Makes healthy options

the default

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

Building Community Momentum to

Improve Health and Equity

Information available at www.preventioninstitute.org

Keep it Local

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

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

http://preventioninstitute.org/component/jlibrary/article/id-75/127.html

$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

Community Partnership

Law Enforcement

Public Health

Violence Prevention

Healthy Eating Active Living

City Council

Youth

Include Co-Benefits

Push the Envelope

Take 2

Steps to

Prevention

Health Care

Services

Exposures & Behaviors

Environment

Photo courtesy of http://tycohealth-ece.com/files/d0003/ty_rn33d7.jpg

Causes of Death

Heart Disease

Cancer

Stroke

Diabetes

Injuries & Violence

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

The 1st

step ...

Health Care

Services

Exposures & Behaviors

Environment

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.

Let’s take

another

step ...

Health Care

Services

Exposures & Behaviors

Environment

Root factors

Compromised

social & physical

environments

EXPOSURES &

BEHAVIORS

HEALTH INEQUITIES ENVIRONMENT

HEALTH CARE

SERVICES

Addressing the Intersection:

Preventing Violence and Promoting Healthy Eating and Active

Living

Healthy

Eating &

Physical

Activity

Safety &

Preventing

Violence

Preventing Violence through Urban Farming

Denver, CO

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

Preventing Violence and Increasing Literacy

Salinas, California

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

Health

Services

Prevention

Integrated Approach

Community-Centered

Health Homes

1. Improve health outcomes overall

2. Advance equity

3. Reduce health care demand and

costs

Shared Goals:

Community Prevention &

Health Care

Community-Centered

Health Homes

Patient-Centered

Health Homes

Medical

Homes

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

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

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

1.) Community Transformation Grants

2.) National Prevention Strategy

3.) Center for Medicare and Medicaid Innovation

Opportunities for Prevention

Center for

Medicare & Medicaid Innovation

Patient Care Models

Seamless & Coordinated Care

Models

Community & Population Health

Models

Center for

Medicare & Medicaid Innovation

Improved Quality of Care

Reduced Costs

National Prevention Strategy

Strategic Directions

Image Credit: National Prevention Strategy,

June 16, 2011

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

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

Coalitions and Networks

Partnerships

Among

Systems

Health Justice

Education

Push the Envelope

Claiming Health

Claiming Health

Claiming Health

Claiming Health

We’re Not Buying It

We Need All Our Voices

to Build a Movement

Photo Credit: http://www.historycooperative.org/journals/jah/91.4/images/hall_fig01b.jpg

221 Oak Street

Oakland, CA 94607

Tel: (510) 444-7738

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TOOLS

Influencing Policy & Legislation

Changing Organizational Practices

Fostering Coalitions & Networks

Educating Providers

Promoting Community Education

The Spectrum of Prevention

Strengthening Individual Knowledge & Skills

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

Links Between Violence and Health

THRIVE

Tool for

Health and

Resilience

In Vulnerable

Environments

http://preventioninstitute.org/thrive/index.php