Larry Cohen, MSW Executive Director

Larry Cohen, MSWExecutive Director

We Know What To Do: Preventing Violence

Creates Thriving Communities

@preventioninst

http://www.facebook.com/PreventionInstitute.org

Boulder, COOctober 8, 2013

Child Restraint & Safety Belt Use

B E Y O N D

Brochures

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

“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

“No epidemic has ever been resolved by

paying attention to the treatment of the

affected individual.”

- George W. Albee

Population-based Focuses on prevention Reduces risks Increases protective

factors

A Public Health Approach to Violence

www.preventioninstitute.org/UNITY

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

MOVINGUPSTREAM

“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 Photo Credit:

http://static.flickr.com/90/207590972_a30260c293_b.jpg

The Prevention Continuum

Up Front In The Thick Aftermath

Immediate responses

AFTER violence has

occurred to deal with the

consequences in the short-term

Long-term responses

AFTER violence to deal with the lasting consequences and treatment interventions

Approaches that take place

BEFORE violence has occurred to

prevent initial perpetration or victimization

Violence Prevention in Public TransportationWashington, DC, USA

Source: Wikipedia. http://en.wikipedia.org/wiki/File:Washington_DC_metro_station_bethesda.jpg

NORMSsanction behavior

attitudes, beliefs, ways of being

based in culture & tradition

taken for granted

more than a habit

behavior shapers communicate regularity in behavior

The ideas of one generation become the instincts of the next.

- D.H. Lawrence

“

”

HEALTH & SAFETYBEHAVIORBEHAVIOR

ENVIRONMENT

Photo courtesy of Latino Health Access

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.

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: Michelle Mockbee Flickr

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

Oakland, CA

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

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

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

INJURIES, ILLNESS & INEQUITIES

EXPOSURES &

BEHAVIORS

HEALTH CARE

SERVICES

ENVIRONMENT

The Trajectory of Health Inequities

Take 2 Steps to Prevention

Medical CareExposures

& BehaviorsEnvironmen

t

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

What’s Sold and How It’s Promoted

What’s sold & how it’s promoted

Elements of Community Health

PLACE

Liquor Store ClosingsLos 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.

Social networks & trust Participation & willingness to act

for the common good Acceptable behaviors & attitudes

Racial justice Jobs & local ownership Education


Look, feel & safety Parks & open space Getting around Housing Air, water, soil Arts & culture


PEOPLE

PLACE

EQUITABLE OPPORTUNITY

Preventative services Access Treatment quality, disease

management, in-patient services, & alternative medicine

Cultural competence Emergency response

MEDICAL SERVICES

ActivityTaking 2 Steps To Prevention

The 1st step ...

Health Care Services

Exposures & Behaviors

Environment

Two Steps To Prevention ActivityA. Health

IssueB. Exposures/

BehaviorsC. Community Health

Factors D. Community

Goals/Indicators

• Tobacco Use / Smoking• Diet & Inactivity• Alcohol• Microbial agents• Toxic agents• Firearms• Sexual behavior• Motor vehicles• Illicit use of drugs

• Getting around• Parks and open space• Arts and culture• Social networks and trust• Participation and willingness to

act for the common good.• Norms/Costumbres• Look, feel and safety• Housing• Air, water, soil• What is sold /how it’s promoted• Racial justice & relationships• Jobs and local ownership• Education

Circle the Exposures/ Behaviors listed below that are related to your health issue.

Circle the factors below that are related to your health issue.

List specific examples from your community of the community health factors you circled in column C. Choose up to 3 examples for each factor.

Type 2 Diabetes

Let’s take another step ...

Health Care Services

Exposures & Behaviors

Environment

Two Steps To Prevention ActivityA. Health

IssueB. Exposures/

BehaviorsC. Community Health

Factors D. Community

Goals/Indicators

• Tobacco Use / Smoking• Diet & Inactivity• Alcohol• Microbial agents• Toxic agents• Firearms• Sexual behavior• Motor vehicles• Illicit use of drugs

• Getting around• Parks and open space• Arts and culture• Social networks and trust• Participation and willingness to

act for the common good.• Norms/Costumbres• Look, feel and safety• Housing• Air, water, soil• What is sold /how it’s promoted• Racial justice & relationships• Jobs and local ownership• Education

Circle the Exposures/ Behaviors listed below that are related to your health issue.

Circle the factors below that are related to your health issue.

List specific examples from your community of the community health factors you circled in column C. Choose up to 3 examples for each factor.

Type 2 Diabetes

Louisville, KY: Healthy Corner Stores

Louisvilleky.gov

Influencing Policy & Legislation

Changing Organizational Practices

Fostering Coalitions & Networks

Educating ProvidersPromoting Community Education

The Spectrum of Prevention

Strengthening Individual Knowledge & Skills

Parks & open space


PLACE

“. . .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 13Photo Voice Project, Santa Ana, CA

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.

Park Access

Acres of Park Space per 1,000 people

Latino Neighborhoods

31.8

1.7

0.6

Predominantly White Neighborhoods

African American Neighborhoods

Reference: Paul M. Sherer. “The Benefit of Parks.” Trust for Public Land, 2006.

Prospect Park: Before RevivalBrooklyn, NY

Image Credit: Librado Romero, The New York Times

Prospect Park RevivalBrooklyn, NY

Photo Credit: Librado Romero, The New York Times

UNITY City Network Members



UNITY City Network

Oakland

San DiegoTucson

Seattle

MinneapolisDetroit

Denver

St. Louis

Chicago

Louisville

Boston

Newark

Los Angeles

New Orleans

Nashville

PhiladelphiaClevelandRichmond

Houston

(San Jose)

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

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

UNITY Assessment

A Coordinated Approach

Image Credit: City of Minneapolis, Summer 612

Minneapolis

UNITY Policy Platform

UNITY Urban Agenda


Programmatic & Service Priorities

Structure & Staffing

Decreased risk factors

Increased resilience factors

Leadership Accountability Coordination Understanding

of violence prevention

Program & Govt Effectiveness

Children & Youth Families Neighborhoods

Violence Prevention Outcomes Intimate partner &

domestic violence Dating violence Sexual assault Child abuse Elder abuse Youth violence Community

violence Homicide Suicide Hate violence Police brutality

A Lifetime Commitment to Violence Prevention: The Alameda County Blueprint

Violence is preventable

Violence prevention is local

Honor what’s working

Respect for diversity

Prevention is not containment or suppression

We are all stakeholders

Violence prevention is a long-term effort

PrinciplesViolence Prevention Blueprint

MINNEAPOLIS, MINNESOTA

Blueprint for Action: Preventing Youth Violence in Minneapolis

Connect all youth to trusted adults

Intervene at the first sign of risk for violence

Restore youth who have gone down the wrong path

Unlearn the culture of violence

Adopted the Blueprint for Action: a Multi-Sector Plan for Prevention.

64 percent decrease in homicides of young people aged 15 to 24 years.

Number of youth suspects in

violent crimes dropped by 62 percent.

Coordinated ApproachMinneapolis, MN

Source:Department of Health and Family Support. (2011, May 24). Results Minneapolis. Retrieved from http://www.minneapolismn.gov/health/yvp/dhfs_data

Street Outreach & Interruption

CeaseFire Chicago

CureViolence (CeaseFire Chicago) demonstrated a 41-73% drop in shootings and killings and a 100%

drop in retaliation murders in three years.

Activities at ALL Levels of the Spectrum in Salinas, California

1. Strengthening Individual Knowledge & Skills

6. Influencing Policy and Legislation

5. Changing Organizational Practices

4. Fostering Coalitions

and Networks3. Educating Providers

2. Promoting Community Education

• Develop public policies to address alcohol as a risk factor for violent behavior • Prioritize economic development and job training for youth •Develop collaboration between City, County, and School Districts to implement this plan

• Develop a strategy to reduce gang violence

• Invest in early childhood and parent support initiatives

• Convene community-wide dialogue on discipline

The Synergy of the Spectrum

“The whole is greater than the sum of its parts.”

63

Norms Are Behavior Shapers

focus on norms

can help prevent

violence against women

and children.

A

5 Key Norms

Narrow Definitions ofMasculinity

Limited Roles for Women

Power &Control

Privacy and SilenceViolence

Success storiesDon Imus, host of CBS’s radio talkshow “Imus in the Morning” fired for racist & sexist remarks

Tony Kornheiser of ESPN’s “SportCenter” suspended for inappropriate remarks concerning co-worker Hannah Storm.

Addressing the Intersection: Preventing Violence and Promoting

Healthy Eating and Active Living

Healthy Eating & Physical Activity

Safety & Preventing Violence

The Intersection

A) Violence and fear of violence affect individual behaviors related to healthy eating and active living.

B) Violence and fear of violence diminish the community environment, reducing support for healthy eating and active living.

“Reality and perception of violence are justifications for people not being outside or letting children outside, and not walking to

places that they normally would”

-Community Leader

“We have a wonderful gym in the park, but the kids don’t use it because they are afraid of the

park.”

“Turf wars deter people from walking to grocery stores.”

“Community safety is our number one concern. If our employees feel unsafe coming to work, or our patrons are scared to shop in the area, we won’t open a store there.”

– Head of Security at a major retail corporation

Creating Safe Spaces

Joint use agreements

Safe routes to school

Afterschool programming

Aesthetics

Safety-promoting features

Preventing Violence by Improving Neighborhood Public Spaces

Chula Vista, CA

Safe Routes to School

Due to safety concerns at the nearby park, parents did not allow children to walk to school

The Bushmaster Neighborhood committee began a walking school bus

A “No Sales 40” initiative banned the sale of 40-ounce glass bottles of alcohol around the park to reduce crime.

Flagstaff, AZ

The Built Environment and SafetyMedellin, Colombia

Source: Vargas VA and García PV. Violencia urbana, seguridad ciudadana y políticas públicas: la reducción de la violencia en las ciudades de Bogota y Medellin (Colombia) 1991- 2007.Bogota: Universidad Nacional de Colombia. 2008.

Providing Land Rights & Reducing Alcohol Abuse

Diadema, Brazil

Source: Echeverri Restrepo, Alejandro . Hacia un Urbanismo Social. Medellin: Empresa de Desarrollo Urbano de Medellin. Colombia. 2008.

Fostering Social Cohesion

Photo courtesy of Get Moving Kern and Greenfield Walking Group

Multi-Field Collaboration

Partnership

Law Enforcement

Public Health

Violence Prevention

Healthy Eating Active Living

City Council

Youth

Interdisciplinary Collaboration Strengthens Outcomes

Brings together diverse expertise

Combines advocacy power

Provides access to more constituencies and networks

Creates greater focus on common goals

Fosters sustainability

Appeals to many funders

Collaborator 4Expertise:

DesiredOutcomes:

Key Strategies:


DesiredOutcomes:

Key Strategies:


DesiredOutcomes:

Key Strategies:


DesiredOutcomes:

Key Strategies:

Shared Outcomes

Partner Strengths

Joint Strategies

Collaboration Multiplier

Preventing violence through urban farmingDenver, CO

Public Health

Urban Agriculture

Violence Prevention

City Council

Parks & Recreation

Youth

Community Development

Faith-based Orgs

Planning Department

School

PromotoresCommunity Health Education

Expertise Desired Outcomes Strategies

Law Enforcement

Optometry n Utilize color and design features to increase driver attention to traffic signals and signs

n Expertise in legal requirements and crash investigations and has the authority to enforce traffic laws

n Enforce traffic laws, patrol neighborhoods, implement check points, cite reckless drives, and participate in educational campaigns

Transportation Engineering

n Road and sidewalk design that provides safe travel for multiple modes of transportation

n Promote safety regulations for occupants and vehicles n Implement street designs that promote safety

Public Health

n Population-based prevention approaches and data collection of injury rates

n Facilitate environmental and policy changes (i.e., pedestrian/bicycle-friendly street design, car seats, seat belts, driving under the influence, bicycle helmets)

Phase I: Information Gathering

n Understanding of how people visualize traffic signs and signals

n Increase compliance to traffic safety laws

.

n Prevent traffic crashes and reduce severity of injuries if a crash occurs

n Reduce unintentional injuries among all travelers, including drivers, pedestrians, bicyclists, disabled, elderly

n Improve vehicle displays, traffic signals, and road signage n Better driver assessment for licensing purposes

Health Sector

Economic Sector

Education Sector

Community Services

Sector

Analysis2

Partner Strengths

Shared Outcomes

Joint Strategies

Collaboration Multiplier: Improving Safety and Increasing Access to Healthy Food

+ City CouncilExpertise:

Desired Outcomes:

Key Strategies:

Violence PreventionExpertise:

Desired Outcomes:

Key Strategies:

Public HealthExpertise:

Desired Outcomes:

Key Strategies:

Urban AgricultureExpertise:

Desired Outcomes:

Key Strategies:

CC

VPPH

UA

Collaboration Multiplier: Improving Safety and Increasing Access to Healthy Food

+ City CouncilExpertise:• Knowledge and ability to influence local

policy decisions

Desired Outcomes:•Policies that promote health and safety in the district

Key Strategies:•Help leverage funds for long-term sustainability

Violence PreventionExpertise:•Expertise in youth violence prevention and intervention

Desired Outcomes:•Decreased gang violence and increased positive opportunities for at-risk youth

Key Strategies:•Build youth leadership and connect youth to training and employment opportunities

Public HealthExpertise:•Experience in population-based interventions and collection of data on chronic disease and injury rates

Desired Outcomes:•Unification of collaborative efforts to address violence and chronic disease

Key Strategies:•Facilitate system and policy changes that link healthy eating active living with violence prevention efforts

Urban AgricultureExpertise:•Knowledge on urban food system infrastructure and implementation

Desired Outcomes:•Long-term partnerships to achieve sustainable food systems

Key Strategies:•Create mechanisms for residents to access fresh, affordable healthy foods

CC

VPPH

UA

Public HealthExpertise:• Provide credibility, data and in-kind staff support

Desired Outcomes:• Unification of collaborative efforts by partners to address VP/HEAL

Key Strategies:• Facilitate system and policy changes that link healthy eating active living with violence prevention efforts

PH

City Council CCExpertise:• Knowledge and ability to influence

local policy decisions



Violence Prevention

VPExpertise:•Expertise in youth violence prevention and intervention



Shared Outcomes

Partner Strengths

Joint Strategies/Activities

Public Health PHExpertise:•Experience in population-based interventions and collection of data on chronic disease and injury rates



Urban AgricultureExpertise:•Knowledge on urban food system infrastructure and implementation



UA

City CouncilExpertise:• Knowledge and ability to

influence local policy decisions



Violence PreventionVP

Expertise:•Expertise in youth violence prevention and intervention



Public Health PH

Expertise:•Experience in population-based interventions and collection of data on chronic disease and injury rates



Urban AgricultureExpertise/:•Knowledge on urban food system infrastructure and implementation



Shared Outcomes• Strong partnerships among partner

organizations and community members• Safe community gathering space: Urban farm• Employment for youth and adults• Increased access to healthy foods• Institutional systems and local policies to

promote health and safety

Partner Strengths• Established trust and respect in community• Local policy maker involvement and support• Experience in community engagement and

training• Content expertise• In-kind support• Linked to broader city-wide initiatives

Joint Strategies• Establish urban farm and farmer’s market• Build youth capacity to understand goal and

advocate for environmental and policy changes• Build capacity of leaders• Cultivate relationships and partnerships• Connect youth and community residents to

training and employment opportunities

UA CC

Shared Outcomes

• Strong partnerships among partner organizations and community members

• Safe community gathering space: Urban farm

• Employment for youth and adults• Increased access to healthy foods• Institutional systems and local

policies to promote health and safety

PH VP UA ++ + CC

Sectors that Prevent Violence Community

Services Criminal Justice Economic Education Governance Public Health Social Services

Private Sectors: Business Faith Media

Other Departments: Housing Planning & Zoning Public Works Transportation

Collaboration Multiplier: Improving Safety

+ Community Services

Desired Outcomes:Build residents’ leadership and advocacy skillsIncrease access to city resources and services for communities that have been historically marginalized

Key Strategies:

EducationDesired Outcomes:

Deliver trauma informed education

Key Strategies:Develop alternatives to zero-tolerance disciplineIncorporate social and emotional learning into all curriculum and instruction

HealthDesired Outcomes:Establish a hospital-based violence intervention program

Key Strategies:Conduct a self-assessment on the health agency’s capacity to prevent violence and injury

EconomicDesired Outcomes:

Key Strategies:Subsidize start-up costs for entrepreneurs in disinvested areas

Establish a Business Improvement District

Incorporate Crime Prevention Through Environmental Design into projects

CS

Ed H

Ec

Shared Outcomes

• Shared data to make better decisions• Decisions and programs reflect residents’ priorities• Positive stories about youth incorporated into

communications• Expanded Safe Routes to School to address gangs, graffiti

and blight, alcohol density• Health services provided at schools• Pedestrian and neighborhood shopping districts are safe,

clean and accessible• Marginal retail areas are rezoned with special attention to

alcohol outlet density• Joint Use Agreements • Partnering with youth-serving groups and community-based

organizations to complement school-run activities and supplement the curriculum

• Funded micro-enterprises to address gaps in neighborhood services and encourage youth employment

H Ed Ec ++ + CS

Collaboration Multiplier: Improving Safety

Community ServicesDesired Outcomes:Build residents’ leadership and advocacy skills.Increase access to city resources and services for communities that have been historically marginalized

Key Strategies:

EducationDesired Outcomes:

Deliver trauma informed education

Key Strategies:Develop alternatives to zero-tolerance disciplineIncorporate social and emotional learning into all curriculum and instruction

HealthDesired Outcomes:Establish a hospital-based violence intervention program

Key Strategies:Conduct a self-assessment on the health agency’s capacity to prevent violence and injury

Economic E

Shared Outcomes

Partner Strengths

Joint Strategies/Activitie

s

Shared data to make better decisionsDecisions and programs reflect residents’ prioritiesPositive stories about youth incorporated into communications

Expanded Safe Routes to School to address gangs, graffiti and blight, alcohol densityMarginal retail areas are rezoned with special attention to alcohol outlet densityJoint Use Agreements

Desired Outcomes:

Key Strategies:Subsidize start-up costs for entrepreneurs in disinvested areas

Establish a Business Improvement District

Incorporate Crime Prevention Through Environmental Design into projects

A good solution solvesmultipleproblems.Prevention Institute

Community-Centered Health Homes

A Different Way to Think about Health Care

Photo Credit: Daniel Bernstein

“The last time we looked in the book, the specific therapy for malnutrition was food.”Jack Geiger, MD

Medical Equipment

Community-Centered Health Homes

Patient-Centered Health Homes

Medical Homes

Photo Credit: http://metes.wordpress.com/2009/01/25/diagonal-crosswalks/

Oakland Chinatown

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

OUTCOMES

IMPROVED HEALTH

COST SAVINGS

EVIDENCE-BASE FOR EFFECTIVE PRACTICE

CLINICAL/COMMUNITY POPULATION HEALTH INTERVENTION MODEL

Existing Clinician Skills PATIENT INTAKE DIAGNOSIS TREATMENT

Transferable to Community Prevention

“We are bringing together the health and human rights voices in south LA and beyond to discuss the healthcare crisis and how we build a movement for the right to health.”-Jim Mangia, CEO St. John’s

Social networks & trust Participation & willingness to act

for the common good Acceptable behaviors & attitudes

Racial justice Jobs & local ownership Education


Look, feel & safety Parks & open space Getting around Housing Air, water, soil Arts & culture


PEOPLE

PLACE

EQUITABLE OPPORTUNITY

Preventative services Access Treatment quality, disease

management, in-patient services, & alternative medicine

Cultural competence Emergency response

MEDICAL SERVICES

Inquiry: Housing Questionnaire

Analysis: Collaborative to Assess Housing

Conditions

Strategic Actions for a Just Economy

Esperanza Community Housing Corporation

Los Angeles Community Action Network

St. John’s Well Child & Family Center

Action: Policies that Improve Health

Outcomes

POLICIES: LA City Attorney’s Office; LA County Department of Public Health

Landlord Compliance

Action

Community Engagement

Health Education

Medical Care

Advocacy

Litigation

“ The first of all freedoms is freedom

from violence.

The first of all rights must be the right to

safety.”

-Connie RiceDirector, LA Advancement Project and author of ‘Power Concedes Nothing’

We Must Prevent Violence

“Intellectuals solve problems.

Geniuses prevent them.”

Albert Einstein

We Can Prevent Violence

“ Violence is not the problem of one neighborhood or group.

Coming together and owning this problem and the solutions are

central.”

-Dr. Deborah Prothrow-Stith Harvard School of Public Health

UNITY Co-Chair

We Need All Our Voices to Build a Movement

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

Larry Cohen510-444-7738

[email protected]

Explore UNITY resources at preventioninstitute.org/unitylinksSign up for alerts at preventioninstitute.org/alerts

www.preventioninstitute.org/unity

Connect with us on

Larry Cohen, MSW Executive Director

Documents

Transcript of Larry Cohen, MSW Executive Director