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A SYSTEM OF PREVENTION Achieving Health, Safety, and Wellbeing for All


Systems come in many forms, from the human body, to our social networks of friends and family, to the systems we construct together that shape our lived experience, such as our transportation and education systems. Drawing on the lessons of prevention successes that have dramatically increased the length and quality of people’s lives, this book describes what it would look like if we aligned the resources and efforts of multiple sectors, and the knowledge and experience of communities about what works, to create a System of Prevention. It is meant to stimulate dialogue and catalyze collaboration among community and health leaders and their partners who seek to create healthy and safe communities for all.


A SYSTEM OF PREVENTION Achieving Health, Safety, and Wellbeing for All

By Prevention Institute Designed by Celery Design Collaborative This book was supported by a grant from The California Endowment


Foreword

A few years ago, I was asked to testify before a committee of the California Legislature on the need to increase funding for the state’s public health infrastructure. As a former local public health officer who had been involved in responding to outbreaks of tuberculosis, whooping cough, and even anthrax, I knew that our public health system was strained in many ways. But how would I convince these busy politicians to sit up and focus on public health infrastructure (yawn) considering the other pressing issues that they faced every day? Turns out I am very lucky. I live in California, and there is something about this wacky place that every now and then gets us to focus on the Big Picture. In California, we have taken on environmental issues such as waste recycling and composting, and we have even confronted climate change with comprehensive legislation. Each of these efforts required establishing a new system with aligned incentives among multiple actors so that each participant would cooperate and “row in the same direction.” As I thought about this, I started to view the public health infrastructure in an entirely different way. It isn’t merely passive infrastructure, it delivers real value. Public health infrastructure vaccinates our children, ensures the safety of our food and water, and arms us with critical information to protect ourselves by making healthy choices. The public health infrastructure is really better understood as the backbone of a system, a System of Prevention. Eureka!

The reason this matters so much is that American health status has plateaued, and there is some evidence that it is actually in decline. We pay exorbitant costs for downstream medical care and wonder drugs for health problems that in many cases could have been prevented. We are dying for lack of a systematic way to invest in strategies to facilitate more exercise, encourage healthy eating, reduce violence, and reduce unnecessary stress. We are dying for want of a System of Prevention. In this book, we describe what this System of Prevention could look like and how we, as champions of health, could invest our time, energy, and creativity in a systematic way to keep people from becoming sick and injured in the first place and produce better outcomes for people who are disproportionately harmed by preventable illness and injury. We hope it makes explicit what you already know and believe and serves as a tool to share this thinking with others.

Tony Iton, senior vice president, The California Endowment


Table of Contents

ABOUT PREVENTION INSTITUTE

PART ONE

Prevention Institute was founded in 1997 as the national center for developing and advancing the practice of primary prevention. We work to shift the overarching mindset and approach to health from one that focuses solely on treating sick individuals to one that prevents disease, violence, despair, and injury before they occur. Our mission is to build prevention and health equity into key federal, state, local, and organizational policies and actions to ensure that the places where all people live, work, play, and learn foster health, safety, and wellbeing.

WHY SYSTEMS MATTER 

For more information, visit www.preventioninstitute.org.

ABOUT THE CALIFORNIA ENDOWMENT

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What are systems and how do they relate to health and equity?

PART TWO

A SYSTEMS APPROACH TO HEALTH

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Why apply a systems approach to health and prevention?

The California Endowment is creating places where children are healthy, safe, and ready to learn. A private, statewide health foundation, The Endowment was established to expand access to quality health care for underserved individuals and communities, and to promote fundamental, affordable improvements in the health status of all Californians. For more information, visit www.calendow.org.

PART THREE

BUILDING A SYSTEM  OF PREVENTION

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It’s time to build on what we know has worked.

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PART ONE

WHY SYSTEMS MATTER What are systems and how do they relate to health and equity?

SYSTEM (def.) A set of things working together as parts of a mechanism or an interconnecting network; a complex whole.

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“Systems thinking is a discipline for seeing wholes. It is a framework for seeing interrelationships … for seeing ‘patterns of change’ rather than static ‘snapshots.’” —Peter Senge, senior lecturer in Leadership and Sustainability at the MIT Sloan School of Management

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Systems are part of our daily lives People have designed systems to solve many complex challenges and create innovation. Systems can have impacts that are greater than the sum of their component parts. Although it might seem like systems are something that are outside of us, we’re actually part of many of them. We shape systems by creating them and interacting with them, and systems shape us—influencing our experiences, understanding, opportunities, and behaviors. We can design new systems that are fair and equitable or influence existing systems to produce more equitable health and safety outcomes.

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Transportation An effective transportation system enables people to safely get from one place to another whether they are on foot, bike, train, bus, or car. Developing an effective, equitable transportation system draws on the skills of multiple sectors, aligning their efforts with community priorities and embedding community perspectives in decision-making.


Water

Radio

We all need safe and clean water in order to be healthy. A holistic water system manages drinking water, groundwater, stormwater, and wastewater. Most US cities were founded near waterways. Water systems have the potential to provide jobs, beautify communities, and create opportunities where people need them most.

Nowadays a radio seems ordinary, but before its invention, who would’ve imagined that coils, wires, and magnets could be put together to produce radio waves that transmit music? The radio reminds us that linking elements in creative ways can be transformative.

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Systems are interconnected We often think of the systems we construct as being distinct from each other and operating independently. The systems we interact with in our daily lives impact and interconnect with one another through policies, practices, decision-making, and resource allocation.

HOUSING TRANSPORTATION

“Many of the strongest predictors of health and wellbeing fall outside of the healthcare setting. Our housing, transportation, education, workplaces, and environment are major elements that impact the physical and mental health of Americans.� -Regina Benjamin, former US surgeon general

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Many systems influence health outcomes Health outcomes, including how long people live and how good their health-related quality of life is, are powerfully influenced by the systems that make up the community environment. These include our food system, our education system, our housing system, and many others. The impact of these systems on people’s health is even greater than the impact of the quality of their healthcare. And, too often, these systems produce inequitable health and safety outcomes for people with low incomes and people of color. But it doesn’t have to be that way.

E D U C AT IO N

Factors that influence health

40 %

SOCIAL & ECONOMIC FACTORS

“It is unreasonable to expect that people will change their behavior easily when so many forces in the social, cultural, and political environment conspire against such change.”

10 % PHYSICAL ENVIRONMENT

20 % CLINICAL CARE

-National Academy of Medicine

30 %

BEHAVIORS

WORK 9


Systems can be redesigned to create health equity

Land use and planning FROM land-use and planning policies that increased racial segregation, like the Housing Act of 1937, which required residents of public housing developments to be of the same race as the neighborhoods where the developments were located.

Good health is not experienced evenly across society. Heart disease, cancer, type 2 diabetes, stroke, injury, mental illness, substance abuse, poor birth outcomes, and violence occur in higher frequency, earlier, and with greater severity among people with low incomes and communities of color. This is not coincidental, and it is not about poor choices or only about access to quality healthcare. These poor health outcomes have been produced by historical and current-day policies, laws, practices, and procedures that have segregated too many people from the resources and opportunities to be healthy.

HEALTH EQUI TY [def ]: Health equity means that everyone has a fair and just opportunity to be healthier. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and healthcare.

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Education FROM education policies that disproportionately harm students of color, like “zero-tolerance� policies that mandate suspension or expulsion for disruptive behavior and have resulted in more severe punishment of African-American children.


TO land-use and planning policies that benefit the communities that are most in need, like the Quimby Park Reform Bill in Los Angeles, California, which ensured that funds set aside for parks and recreation facilities could be used in the communities that had the fewest parks.

TO education policies that support young people who’ve experienced trauma and hardship, like the approach advocated by California’s Leadership and Learning Network in the Central Valley, which uses positive behavioral interventions to hold kids accountable and teach them responsibility and respect while keeping them in school.

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We can design systems that support health and safety for all

TRANSPORTATION Local food systems strengthen local economic opportunity, reduce greenhouse gas emissions, and reduce air pollution.

When we have outcomes like equitable health, safety, and wellbeing in mind, we shift expectations for how systems should perform and what they should accomplish. After recognizing a pattern of illness, injury, or health inequity, we then seek to understand how that pattern is fostered by policies and practices. From there we can move from understanding to action, by shifting decision-making and resource allocation to ensure systems are designed to produce better health and safety outcomes for all people.

Designing a better food system Many communities are rethinking the system that gets food from farm to table. Local partners in economic development, farming, environmental stewardship and conservation, labor, land use, and transportation all have a role to play in making the vision of a healthy, equitable, and sustainable food system a reality.

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1 FAR M Policies, agricultural practices, and programs foster sustainable food production.

2 PR OC ESSING A focus on justice at every level of the food system supports safe and fair working environments for workers within the food system.


RETA I L Improved access to healthy, affordable food in retail settings and institutions, and limits to the marketing of junk food make communities healthier places to live.

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5 TA BL E Increased access to healthy, sustainable, equitably produced foods fosters better eating habits and can strengthen the social fabric of neighborhoods.

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PART TWO

A SYSTEMS APPROACH TO HEALTH Why apply a systems approach to health and prevention?

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“The function of protecting and developing health must rank even above that of restoring it when it is impaired.” —Hippocrates

PRIMARY PREVENTION (def.) Actions taken prior to the onset of illness and injury that will reduce the likelihood of that illness or injury ever occurring. Primary prevention promotes safe and healthy environments at the individual, family, community, and societal level, often through organizational practice and governmental policy change. These environments will provide opportunities for and encourage healthy behaviors.

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Prevention works The concept of prevention has been around for as long as people have understood that it is far better to be safe and healthy than to be sick or injured. Early efforts to establish public sanitation and clean drinking water systems clearly demonstrated the vital, cost-saving, and effective role of prevention. Efforts to reduce tobacco use and automobile deaths offer modern-day examples of the power of systems-level changes to save lives. In each of these cases, people recognized a problem and organized for change, engaged a diverse set of partners, and took action at multiple levels to change policies and practices. As a result, they transformed public understanding of these issues and dramatically shifted cultures and norms, advancing health and safety.

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TOBACCO USE (% of adults who smoke)

1964

The US Surgeon General released a landmark report linking smoking and lung cancer.

AUTOMOBILERELATED DEATHS

1970s

Multi-level actions included banning TV and radio ads and printing strong warning labels on cigarette packets.

(fatalities per 100 million vehicle miles traveled)

1962

Multi-level actions included laws like New York State’s law requiring front seat belts in cars.

1978

Over time, states took on other aspects of auto safety. Tennessee was the first jurisdiction in the U.S. to pass a child passenger safety law.


1974

Connecticut passed the first state law to apply smoking restrictions in restaurants.

1984

California’s first multi-city coalition to promote smoking restrictions included organizations like the American Cancer Society, American Lung Association, and local public health departments.

1998

A legal settlement reached with the country’s five largest tobacco companies required the tobacco industry to pay the plaintiff states approximately $10 billion annually.

1980

Community leadership played an important role, such as when Mothers Against Drunk Driving was founded by a woman whose daughter was killed by a drunk driver.

2000

Community-led coalitions pushed for additional automobile safety legislation like Washington State’s booster seat law for children under 40 pounds.

2007

The involvement of national advocates and the automobile sector led to the development of vehicle safety technology like Electronic Stability Control.

2014

Businesses like CVS Caremark changed their organizational practices and stopped selling cigarettes and other tobacco products at their stores.

2016

New partnerships like the Vision Zero Network broadened prevention efforts to areas such as transportation planning.

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Prevention reduces healthcare costs A health system aimed at prioritizing prevention of illness and injury would target healthcare, mental health, and public health resources toward the factors that have the greatest influence on health. Instead, only a miniscule amount of health expenditures go toward prevention efforts that improve community environments.

Where do our health dollars go? Medical high utilization is one major source of spending in our health system. Though only a small portion of the population, medically complex patients with high utilization of medical services often require treatment for multiple compounding conditions such as physical illness, serious mental illness, and substance abuse. A confluence of factors—housing instability, inadequate education, social isolation, lack of access to economic opportunity, for example, and persistent exposure to racism and discrimination—collide to produce poor health, trauma, and injury.

5% of the population uses 50% of medical services each year. This accounts for 9% of the nation’s entire GDP.

H IG H U T IL IZ AT ION CAN R E S U LT F R OM M U LT IP L E C H R ON IC C O N D IT ION S

Mental illness

Alcohol/drug dependency Asthma Chronic obstructive pulmonary disease (COPD) Heart disease

Type 2 diabetes

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Many of these conditions are preventable.


S O C IAL N E T WO RKS & T R U ST Fostering peer support networks improves physical and mental health, as well as emotional stability.

W H AT’S SOLD & H OW I T ’S P R O M OT ED Incentivizing healthy food outlets supports increased access to and consumption of healthy food.

We can reduce illness and injury and avert the most costly conditions through equitable investments that improve the resources, opportunities, and conditions in community environments.

HOU SING Increasing safe and affordable housing facilitates health and the overall ability of families to make healthy choices.

LI VI N G WAG ES & LOCA L WEA LT H & AS S E T S Creating quality jobs and economic opportunities provides people the income they need to access healthy neighborhoods and healthpromoting resources.

LO O K , F EEL & SAFETY Increasing safe park space and lighting promotes wellbeing, encourages physical activity, and reduces violence.

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Prevention must be brought to scale It takes the work of many sectors to build systems designed for health, safety, wellbeing, and equity. The creation of a System of Prevention can enable multiple sectors to collaborate to:

Community safety is impacted by the policies and practices of these sectors, among others:

Cradle-to-career educational system

· Align resources with an explicit priority of preventing illness and injury Education Economic development

·Close gaps in health and safety outcomes for the benefit of everyone ·F  oster new skills, policies, and practices to support communities’ health

Housing

Safe communities through preventing violence

Justice and law enforcement

Human/social services Parks and recreation Workforce development

Sustainable food system

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Active transportation for health and safety


Community-centered health system

Safe and affordable housing

“We … need to look at the relationship between transportation, housing, jobs, and schools. We have to be very deliberate about making sure that these systems actually benefit marginalized communities. To do that, you have to make sure that marginalized communities have a voice and an input.” – john a. powell, director, Haas Institute for a Fair and Inclusive Society

Economic development in service of communities

Healthy, equitable land use and planning

Thriving community collaboratives that prioritize prevention and equity solutions

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What are the overarching principles of a System of Prevention? · A System of Prevention needs leadership and collaboration · A System of Prevention is community driven · A System of Prevention should seek equitable outcomes, by design

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A System of Prevention needs leadership and collaboration A growing chorus of health, justice, and community leaders are calling for a prevention approach to reduce needless sickness, death, and suffering. The health sector can seize the opportunity to be champions of this approach, and lay the groundwork for a shift away from systems that only respond to illness and injury after they occur, and toward a robust System of Prevention—that takes action to systematically prevent inequities in illness and injury.

“The health sector is uniquely positioned to build the partnerships, lend our knowledge and data, and help create the support and momentum for social change.” – Karen DeSalvo, former Acting Assistant Secretary for Health at the U.S. Department of Health and Human Services

People power and partnerships for prevention In collaboration with community members, health leaders can forge a shared vision—one that centers on prevention and equity—and partner with other sectors to strengthen momentum toward the goal.

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A System of Prevention is community driven Community residents, leaders, and faith- and communitybased organizations have deep knowledge and experience working to create systems change in their communities. They are in a unique position to leverage people power, resources, community credibility, and advocacy know-how to ground a System of Prevention in community-driven priorities and solutions. A System of Prevention should be accountable to and guided by community perspectives and broad participation to achieve equitable health outcomes for people of color, people with low incomes, or any marginalized group.

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From seed to system A System of Prevention builds upon the resources and assets within communities, government, and other key institutions to move toward health equity-producing, community-centered, sustainable efforts. A System of Prevention is built over time. It may grow from a fledging local initiative and gradually become embedded into institutions, policies, and practices.


A System of Prevention should seek equitable outcomes, by design Focusing on systems-level change can facilitate inclusion and fairness. It opens the door to address the less visible ways that systems produce inequities—such as bias and discrimination, diminished opportunities, and community trauma. By bringing together champions, building multisector partnerships, aligning resources, and drawing on community experience with the intention to achieve equitable outcomes, a System of Prevention can create the conditions that catalyze improvements in community environments for all.

“All the tools, techniques, and technology in the world are nothing without the head, heart, and hands to use them wisely, kindly, and mindfully.” -R asheed Ogunlara, coach, speaker, author

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PART THREE

BUILDING A SYSTEM OF PREVENTION It’s time to build on what we know has worked.

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SYSTEM OF PREVENTION By design, a System of Prevention will encompass an array of prevention strategies, carried forward by diverse stakeholders, in diverse sectors, all aimed at shifting social conditions, policies, practices, and resources to advance health, safety, and wellbeing in all communities.

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Elements of a System of Prevention

Develop a shared vision

There is no single recipe for any one community to guide the creation of a System of Prevention. But there are common ingredients. By studying core elements of past prevention and public health successes, we have identified eight key elements of a System of Prevention. They are interrelated, and work synergistically to advance health, safety, wellbeing, and equity. Depending on the community and the health and safety issues at play, the order in which the elements are put into place will differ.

Engage in multi-level action

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Facilitate community partnerships and multisector collaboration

Elevate community voices and leadership


Empower a skilled prevention workforce grounded in social justice

Generate stable sources of funding

Make the case for prevention and equity

Gather and share data to support prevention efforts

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Develop a shared vision Establishing a clear vision can provide leaders advancing a System of Prevention with a unified sense of direction. A shared vision can be achieved by scanning the landscape to understand assets, allies, and potential barriers to change. What are the underlying determinants of health? Is the community safe? Is healthy, affordable housing available for all? Is quality transportation accessible to diverse users? Who are the key players needed to take action to address each determinant? A shared vision brings people together in new ways to achieve prevention and health equity successes.

Engage in multi-level action Past prevention successes have taught us that a systematic set of thoughtful, community-focused actions is essential. A successful prevention strategy will create synergy at different levels, including policy, organizational practices, coalitions and networks, provider training, community education, and individual skill-building. Policy and organizational practice change must be included to ensure sustained, broad-based impact. Coordinated action reflects a commitment by System of Prevention partners to act together, and to be guided by the priorities and values of communities experiencing health and safety inequities. Data and evaluation inform action at every level.

THE SPEC TR U M OF PR EV ENTION A comprehensive strategy includes a range of actions, all the way from individual knowledge and skill building to large-scale policy change.

Influencing Policy & Legislation

Changing Organizational Practices Fostering Coalitions & Networks Educating Providers Promoting Community Education Strengthening Individual Knowledge & Skills

The role of health departments in a System of Prevention Health departments can provide backbone support and leadership to a System of Prevention. With their emphasis on population-wide health, public health practitioners bring a nuanced understanding of how social, economic, and physical conditions shape health and safety outcomes, and create and perpetuate—or reduce and eliminate— inequities. Using a methodological approach that focuses on moving upstream to prevent illness and injury in the first place, health departments can establish a model for governmental practices across sectors. 30

A SYSTE M O F P R E V E N T I ON


Elevate community voices and leadership

“[Community and government leaders]

Equitable health and safety outcomes cannot be produced by formal institutions alone. Community engagement, participation, and leadership are central to a System of Prevention, amplifying the voices of those who have been traditionally under-represented as stewards of the system.

have investe d the time in humanizing each other—it’s more than a c onstituent and lo cal government relationship. We can move past challenges b e caus e we’re investe d in this relationship.” —A ndrea Manzo, regional equity director, Building Healthy Communities: East Sali­n as

“Through c ollab oration with “Let’s develop alternative spac es that build a critical analysis around health and health outc omes and let p e ople organize, building the capacity of p e ople to b e able to group thems elves together and fo cus on thes e issues.”

c ommunity partners, [the lo cal b oard of health] has b e en able to advanc e its thinking and work on the governmental systems and structures that challenge p e ople’s ability to live healthy lives.” — G regory Brown, executive director, PolicyBridge

“It’s imp ortant to c ome together … b e caus e we ne e d to have our voic es heard. We have the chanc e to not have thes e problems pass on to the next generation. We can heal our c ommunity and reunite families.” – Youth leader

– Community partner

C OM M U NITY ( d ef.) Community is both a feeling and a set of relationships among people. People form and maintain communities to meet common needs. Members of a community often have a sense of trust, belonging, safety, and caring for each other. They have an individual and collective sense that they can, as part of that community, influence their environments and each other.

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A System of Prevention provides an organizing frame for many different sectors to come together. By looking at the roles and contributions of multiple sectors, we can identify levers for actionable change.

C LI

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C IAL S

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P O RTA T NS

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A System of Prevention will require leadership and buy-in from a broad range of sectors whose policies, funding decisions, and practices greatly influence whether more equitable health and safety outcomes are realized.

EALTH

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Facilitate community partnerships and multisector collaboration


DEVEL

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Collaboration often happens in dyads and triads. Think about what subsets of cross-sector partners can do together to achieve the broader goal.

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California’s Health in All Policies Approach: A model of multisector collaboration

AND MAN

A potent example of intergovernmental partnership, California’s Health in All Policies Task Force brings together over 22 departments, agencies, and offices from across state government to incorporate health, equity, and sustainability into decision-making across sectors and policy areas. “In the beginning,” says Julia Caplan, director of the California Health in All Policies Task Force, “this was really about understanding what [the departments’ and agencies’] priorities were and figuring out how to help them achieve their goals in a way that also promoted health and equity. Now, health and equity are normal parts of conversations that are happening within government; they are considered in decisionmaking in a wide variety of areas.” 33


Empower a skilled prevention workforce grounded in social justice A System of Prevention will need a diverse, committed cadre of community and health leaders, steeped in a shared vision for building such a system, and equipped with the skills to systematize prevention practice. System of Prevention leaders will connect the dots across multiple sectors and issues, convene partners, and craft solutions with co-benefits. And they will address racism, discrimination, and other forms of institutional injustice to improve health and safety outcomes equitably. People working in health and public health already have many skills and strengths that can be leveraged. Academic and vocational institutions can also play a central role in building a new generation of leaders.

Make the case for prevention and equity Momentum for change most often comes from the stories we tell each other and the solutions those stories lead us to. Strong, strategic communications can help build and sustain prevention and health equity efforts. Community leaders and residents are credible messengers for social change. Influential leaders in the health sector and public sphere can echo and amplify community values and priorities, and advocate for systems-level solutions.

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Community experience illuminates the data

Gather and share data to support prevention efforts Achieving full opportunity and optimal health requires developing research methodologies that align with community values and set the stage for upstream priorities and action that can make a difference in the health and wellbeing of the overall populace. Contextual and experiential evidence, including community insights into useful strategies and action, will play as important a role as traditional sources of evidence, such as peer-reviewed studies.

In one Midwest county, the local board of health joined forces with over 100 community partners to inform its community health assessment and develop a plan for the future. The assessment measured social and community conditions including economic stability, education level, access to safe places to be active, and availability of healthy food. When possible, the data was segmented by race and by place to assist the partners in identifying the communities most impacted by health inequities. The process opened the door to a dialogue among the partners and led to naming the “elimination of structural racism� as a priority goal in the community’s health improvement plan.

Measuring conditions in the community environment can help point the way toward solutions In one urban neighborhood flanked by major freeways and a port, residents jointly identified 17 different community health measures, including asthma rates, household income, and voting power. Residents used the data to educate elected officials and the media about health outcomes and living conditions in the area. This effort eventually led to the closing of the largest toxic polluter in the neighborhood. 35


Generate stable sources of funding A System of Prevention can’t be sustained without adequate and stable sources of funding to support a spectrum of prevention activities. Some of that funding can come from “closing the loop.” That means ensuring that when prevention efforts save money—like when no-smoking policies result in fewer medical expenses for smoking-related illnesses—much of that money gets plowed back into prevention. Other funding can come from money that is generated from taxes and fees on harmful products and practices (like fees on the manufacturers and distributors of soda and alcohol products). All these funding elements can be placed into a prevention fund and pooled with other sources of funding, like government funding, community benefit funding from healthcare organizations, and philanthropic investments.

IN V E ST IN P R E V E N T IO N & EQ U IT Y ST RAT EG IE S

R EAP THE BENEFITS OF IM PR OV ED HEALTH OU TC OM ES

Fund a diverse portfolio of prevention strategies to improve community health, safety, wellbeing, and equity.

Less money is spent on treatment, because preventable health problems are avoided.

P O O L SAV IN G S AN D OT H E R F U N D IN G IN TO A P R E V E N T ION F U N D ; R E IN V E ST T H E M Sources of prevention fund funding: • Prevention-related taxes and fees • Government funding • Philanthropic investment • Community benefit/community reinvestment funds

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CAPTU R E SAV ING S FR OM IMPR OV ED HEALTH OU TC OM ES Savings resulting from reduced expenditures in the healthcare, criminal justice, and other sectors can be reinvested in prevention.


to bring prevention successes to full fruition— to redesign the systems that are part of our daily lives so that they fully embrace the essential role that prevention plays in creating a healthier population, lowering healthcare costs, and improving quality of life. We know prevention works to save lives and prevent unnecessary suffering. Now it’s time to be bold and tenacious, and insist on comprehensive and sustainable approaches to advancing wellbeing, preventing illness and injury, and achieving health equity.

“Let us try to offer help b efore we have to offer therapy. Th at is to say, let’s s e e if we can prevent b eing ill by trying to offer a love of prevention b efore illness.” – Maya Angelou, poet

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Tools and resources for a System of Prevention

Translating theory into action and practical approaches can be challenging. Prevention Institute offers tools and resources to facilitate action toward a System of Prevention. Field-tested and evidence-informed, our tools guide practitioners, advocates, community groups, and policymakers in planning and implementing collaborative, effective prevention strategies. Learn more at www.preventioninstitute.org/tools.

GENERATING PREVENTION SOLUTIONS The THRIVE tool enables communities to determine how to improve health and safety and promote health equity. It can be used to engage community members and partners in assessing the status of community determinants of health—including those in the sociocultural, economic, educational, and built environments—and prioritizing those of greatest importance.

DEVELOPING PREVENTION STRATEGY The Spectrum of Prevention tool supports the creation of a comprehensive plan of action. The Collaboration Multiplier tool allows users to analyze multisector collaborative efforts and design activities to achieve a common goal.

IMPLEMENTING PREVENTION STRATEGY Eight Steps to Effective Coalition Building is a framework for engaging individuals, organizations, and governmental partners in addressing community health and safety. The Community-Centered Health Homes model describes the valuable role healthcare organizations can play to advance health, safety, wellbeing, and equity.

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Systems thinkers and prevention leaders quoted in this book

Page 5: Peter Senge, senior lecturer in Leadership and Sustainability at the MIT Sloan School of Management. Senge’s work is guided by the belief that organizations must apply systems thinking to realize their potential.

Page 31: Youth leader, Building Healthy Communities, Long Beach. Building Healthy Communities youth leaders have been instrumental in designing and implementing the Every Student Matters campaign, which advances restorative justice in schools.

Page 8: Regina Benjamin, former U.S. surgeon general. As surgeon general, Benjamin sought to create a grassroots movement to shift the focus of the health system from sickness and disease to wellness and prevention.

Page 31: Andrea Manzo, regional equity director, Building Healthy Communities, East Salinas. Manzo is focused on amplifying the voices and power of East Salinas residents in the city’s decision-making process.

Page 15: Hippocrates. Known as the father of medicine, Hippocrates advanced the belief that the body must be treated as a whole, rather than a series of parts. Page 21: john a. powell, director, Haas Institute for a Fair and Inclusive Society. powell recognizes how race is intertwined with other urgent issues, such as extreme inequality, mass incarceration, and political participation. Page 23: Karen DeSalvo, former Acting Assistant Secretary for Health at the U.S. Department of Health and Human Services. DeSalvo has dedicated her career to building bridges between sectors and systems to create a health system designed to improve the health of all people. Page 25: Rasheed Ogunlara, coach, speaker, author. Ogunlaru strives to help people from all backgrounds achieve fulfillment, happiness, and self-defined success through his “become who you are” approach.

Page 31: Gregory Brown, executive director, PolicyBridge. Brown advocates that we need to build the full potential of all residents in a community so they can successfully influence the decisions and investments made in their neighborhoods. Page 31: Community partner, Building Healthy Communities Initiative, California. Community partners engage community members and inform and guide priorities for the initiative’s actions. Page 33: Julia Caplan, director of the California Health in All Policies Taskforce. Caplan understands that creating environments that promote health equity requires a multisectoral approach and employs that approach across her work. Page 37: Maya Angelou, poet, novelist, and civil rights activist. Angelou lived her life courageously and always maintained that we must have the courage to stand up for what we believe in and the courage to stand up for others.

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Acknowledgements and photo credits

Pages 6-7 LA transit map: Los Angeles County Metro Rail Kids biking: Jim Henderson Train: Teves Costa Water tower: Art Davis Radio tower: Barbara Maliszewska Radio: Riberto Frederic Pages 8-9 Rural houses: Elizabeth Lies School: Lee Paxton Office: Kenneth Allen Store: iStock Data for determinants of health graphic: County Health Rankings Pages 10-11 Detention slip: Matthew Rutledge Girls playing in park: Alaric Sim Lobbying: Rick Reinhard Prison protest: Flickr, claumoho Boys reading: US Department of Education Dinner table: Flo Dahm Protester holding sign: All-Nite Images Protest group: Fibonacci Blue Redlining map: US Federal Government Classroom: Douglas P Perkins

40

A SYSTE M O F P R E V E N T I ON

Pages 12-13 Farm house: Arno Smit Pages 16-17 Cigarettes: Wikicommons, Lamiot Page 25 Park drawings, LA River clean up: Los Angeles Neighborhood Land Trust Pages 28 Lightbulb: Wikicommons, Edokter Page 35 Top case study features Health Improvement Partnership—Cuyahoga. They also provided the photo. Bottom case study features the West Oakland Environmental Indicators Project. They also provided the photo. Throughout the book: Miscellaneous photos were generously provided by photographers on Unsplash.com and Pexels.com.

Thank you to The California Endowment for its financial support and partnership. Thank you to Juliet Sims and the numerous other Prevention Institute staff members who worked with her to make this project a reality. Thank you to the Celery Design Collaborative for bringing prevention and equity concepts to life through design.


www.preventioninstitute.org

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A System of Prevention  

by Prevention Institute

A System of Prevention  

by Prevention Institute

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