1. Prevention is Primary Published by APHA and Jossey-Bass Edited by Larry Cohen, Sana Chehimi, and Vivian Chavez

2. Agenda Introduction About Prevention is Primary Part 1: Defining the Issues Part 2: Key Elements of Effective Prevention Efforts Part 3: Prevention in Context Closing Question and Answer

3. Objectives Discover frameworks and research available in Prevention is Primary Learn how to use other Prevention Institute tools to complement Prevention is Primary

4. Presenters Larry Cohen, MSW Executive Director Prevention Institute Larry Cohen, MSW Executive Director Prevention Institute Sana Chehimi, MPH Program Director Prevention Institute Sana Chehimi, MPH Program Director Prevention Institute

5. About Prevention Institute Primary prevention Changing norms and policies Focus on health equity

6. Current U.S. health care spending $2.2 Trillion Behaviors & Environment 70% Genetics 20% Medical Care, 10% Factors InfluencingHealth National Health Expenditures SOURCE:Centers for Disease Control and Prevention, Blue Sky Initiative, University of California at San Francisco, Institute of the Future, 2000

7. Current U.S. health care spending $2.2 Trillion Prevention 4% Behaviors & Environment 70% Medical Services 96% Genetics 20% Medical Care, 10% Factors InfluencingHealth National Health Expenditures SOURCE:Centers for Disease Control and Prevention, Blue Sky Initiative, University of California at San Francisco, Institute of the Future, 2000

8. Return on investment with prevention Savings at 5 Years $16 Billion Annual Savings In 5 Years $5.60 Return on Investment $1 Investment SOURCE:Prevention for A Healthy America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, Trust for America’s Health, July 2008

9. Prevention and Public Health Fund, 2010-2019

10. 2011 Health Equity Summit: Oakland, CA

11. Training Future Leaders Motivation for second edition New Sector Alliance Academic outreach Photo Credits: http://uninews.unimelb.edu.au/media/2008_05/girl-studying-outside_rs_ri.jpg http://webmedia.unmc.edu/sorrellphotos/DrMichaelSorrellstudents.jpg

12. Prevention Is Primary: Strategies for Community Well-Being, 2nd ed. 15 chapters, 46 expert contributors Theory, concepts, and models Updated in light of new national recognition for prevention

13. Part 1: Defining The Issues The case for primary prevention Social determinants of health/disparities Resilience-based approaches Related tools: Taking Two Steps Back to Prevention The Spectrum of Prevention

14. Take 2Steps to Prevention Environment Exposures & Behaviors Health Care Services

16. Heart Disease Cancer Stroke Diabetes Injuries & Violence Causes of Death

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

18. 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

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

21. Making Links to Exposures & Behaviors Diet & Activity Patterns Heart Disease Cancer Tobacco Stroke Type 2 Diabetes Alcohol & Drugs Injuries & Violence SOURCE:McGinnis JM , Foege WH. Actual causes of death in the United States. Journal of the American Medical Association. 1993; 270: 2207-2213.

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

24. The Spectrum of Prevention Influencing Policy and Legislation Developing strategies to change laws and policies Changing organizational practices Adopting legislation and changing norms Fostering coalitions and networks Convening groups and individuals for greater impact Educating providers Informing providers who influence others Promoting Community Education Reaching groups with information and resources Strengthening individual knowledge and skills Enhancing individual capacity

25. The Spectrum of Prevention is a tool for changing systems, norms, and environments.

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

27. Example: Breastfeeding

28. The Spectrum of Prevention:Breastfeeding Influencing Policy and Legislation Developing strategies to change laws and policies Changing organizational practices Adopting legislation and changing norms Fostering coalitions and networks Convening groups and individuals for greater impact Educating providers Informing providers who influence others Promoting Community Education Reaching groups with information and resources Strengthening individual knowledge and skills Enhancing individual capacity

29. Part 2: Key Elements of Effective Prevention Efforts Local Business Community organizing Media advocacy Evaluation of primary prevention programs Working collaboratively Related tool: 8 Steps to Building and Maintaining an Effective Coalition Public Transit Health Care Providers Faith Community Public Health

30. 8 Steps to Building and Maintaining an Effective Coalition 8. Make improvements through evaluation 7. Maintain coalition vitality 6. Develop a successful structure 5. Anticipate necessary resources 4. Convene the coalition 3. Devise preliminary objectives and activities 2. Recruit the right people 1. Analyze program objectives and determine whether to form a coalition

31. Part 3: Prevention in Context The built environment Healthy food environments Preventing violence Related tool: Communities Taking Action: Profiles of Health Equity

32. Communities Taking Action: Profiles of Health Equity

33. UNITY builds support for effective, scalable, sustainable efforts to prevent violence before it occurs so that urban youth can thrive in safe environments with ample opportunities and supportive relationships. UNITY is funded by the Centers for Disease Control and Prevention as part of the CDC’s national youth violence prevention initiative, Striving to Reduce Youth Violence Everywhere (STRYVE), and in part by The California Wellness Foundation and The Kresge Foundation. www.preventioninstitute.org/UNITY

34. 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

35. Our tools and frameworks in action Prevention is Primary is used at schools including: University of Pennsylvania San Francisco State University Boston College San Jose State University

36. Other tools that have been adapted for classroom use THRIVE at Case Western Reserve University School of Medicine The Spectrum of Prevention at schools including: University of Pennsylvania School of Social Policy and Practice UC Berkeley School of Public Health Developing Effective Coalitions: An Eight-Step Guide at the University of Pennsylvania School of Social Policy and Practice

37. Publications Order your copy of Prevention is Primary from the APHA Bookstore! http://tinyurl.com/3wq8c9n

39. Stay in touch with Prevention Institute Sign up for e-alerts on our website: www.preventioninstitute.org Follow us on Twitter: @preventioninst Like us on Facebook: www.facebook.com/pages/prevention-institute Find us on LinkedIn

40. Quality prevention is the catalyst for change.

41. Thank you! APHA Jossey-Bass Participants