April 21, 2017

"When we say treatment, we all want the best. When we say prevention, we have no notion of quality,” said Cohen. “[Defining quality in prevention] is at the core of what we do at Prevention Institute."

He shared memorable turning points in his work with the Prevention Institute, which he founded in 1997 as a national non-profit center dedicated to improving community health and well-being by building momentum for effective primary prevention. The Institute's work is characterized by a systems approach to prevention, a strong emphasis on community participation, and promotion of equitable health outcomes among all social and economic groups.

Cohen described how prevention efforts are often reduced to a brochure handed to  patients on the way out of the emergency room, noting that "part of our solution has to be community and prevention, intertwined with focus on equity. No epidemic has ever been resolved by paying attention to the treatment of the affected individual."

Changing Norms and Improving Community Determinants of Health

Cohen described a macro-level approach to build trauma-informed communities and improve community determinants of health, outlining three key steps: 

1. Demonstrate that prevention is working by sharing research and telling stories that influence community members and policy makers. 
2. Clarify what is at stake, explaining how people thrive with prevention or flounder without it. 
3. Link the strategy to shared values, such as keeping our neighbors healthy, saving money. 

Cohen discussed how Prevention Institute tools, such as the Collaboration Multiplier, were used in successful community projects – an uncommon sidewalk that prevented traffic accidents, an urban farm that employed local high schoolers, soda taxes that fund early childhood education – in a way that builds coalitions across sectors.

Cohen noted research showing zip code of residence is a major predictor of life expectancy. In Philadelphia, people in one zip code – Old City’s 19106 – are expected to live up 88 years, a dozen years longer than those in the bordering zip code, Northern Liberties’ 19123, where life expectancy is 75 years.  

To reduce these inequities, Cohen cited an effective advertising campaign by the California Endowment which displayed life expectancies in two neighboring California zip codes within the same political district alongside state policies and legislation that impacted the quality of life in the area where the ads were posted.  Halfway through this 10-year Building Healthy Communities campaign, results indicate improved health coverage for the underserved; strengthened health policy for the undocumented; improved school climate, wellness and equity; prevention and reform support in the justice system; public-private investment and policy changes for boys and young men of color; and local and regional progress on incorporating “health in all policies.”

In the end, Cohen stressed that community coalitions are a key factor in effective advocacy for change. He closed with a quote by D.H. Lawrence: "The ideas of one generation become the instincts of the next.”