The Public Health Approach to Prevention

The four steps of the public health approach

Most of us - 98 percent of the Lane County adults interviewed in a recent survey - share some beliefs about children. We believe they deserve to grow up safe and healthy and that, if they are harmed, it is our responsibility to support and help them in healing. 


This imperative to help those who have been hurt means we have, understandably, focused the majority of our energy on after-the-fact interventions. Of course we want to support children and their families when we learn those children have been harmed. But helping people heal doesn't change the fact they've been hurt in the first place. For that, we need prevention. Prevention doesn't mean we should stop supporting children suffering from neglect or harm. In fact, the organizations, neighbors, and friends who do this work need our support - financial and otherwise - now more than ever.


But we formed 90by30 in recognition of the fact that the work of supporting kids and families will not, on its own, decrease child abuse and neglect. For that we need to target the problem before it happens, so that we're not simply putting a Band-Aid on a wound that constantly reopens. That is known as prevention.


There is no shortage of experts working on the issue of how to best prevent child neglect and abuse. The approach that we have chosen for 90by30 is from the public health model of prevention. This is the model used by the same people who wiped out smallpox worldwide in a 20-year period after they recognized that immunizations could prevent the disease. That realization led to a global health campaign to convince the world to get vaccinated - and it worked.


Rotary International, using the same public health approach, has also nearly eliminated polio across the world.


So what does a vaccine against smallpox tell us about how to find a similar "vaccine" for child abuse?


In the public health approach, the steps to address a complex issue like child abuse are:


Step 1. Define the problem. There are more than a thousand Lane County children and youth who experience child abuse and/or neglect each year. This is something we know.


Step 2. Identify the causes. Next, we must help everyone learn and understand the reasons or factors that lead to child neglect or abuse. Identifying “risk” and “protective” factors gives us an understanding of exactly where to focus our efforts.


Step 3. Make a plan. Now we develop strategies and actions designed to increase protective factors and decrease risk factors. If we are effective in doing these two things, we can and will significantly reduce child abuse and neglect in Lane County.


Step 4. Build on success. Finally, we spread the word about and encourage the widespread adoption of the actions or strategies that research has proven to work.


This commitment to research and evaluation is one reason the 90by30 effort is housed within a major research center, the University of Oregon’s College of Education. Here we will conduct the research that will decide if the actions and the strategies we have adopted for 90by30 are working. The research will also tell us, over time, how to make our strategies even more effective by helping us to adjust or adapt what we are doing to make it better.


When research proves that an action or strategy works, it leads to other groups and people wanting to implement that strategy in their own communities. This widespread adoption of effective actions and strategies will significantly reduce and prevent child neglect and abuse – much like Rotary’s success with nearly eliminating polio.