>> In a diorama, miniature street lamps glow beside a hill of fake rock.
Holes punched into the dark blue sky glow like stars.
The narrator stands on the sandy ground amidst a crowd
of paper cars facing a drive in movie screen.
>> We've just seen how violence is a part of each level of the social ecological model,
which means that violence affects our lives as individuals, families,
community members, and society as a whole.
Now we'll spend some time focusing on prevention.
Remember, keeping our public health perspective in mind, our goal is always
to stop violence before it begins.
>> On the giant screen above her, an interview appears.
The notecard reads, Rodney Hammond, Ph.D., retired,
Centers for Disease Control and Prevention.
>> Violence isn't something that just happens and you can't do anything about it.
But actually you can prevent it.
>> There are three different ways we can think about the timing of violence prevention efforts;
primary, secondary, and tertiary.
That is, we can prevent violence before it happens.
>> A dangling notecard reads, primary prevention equals before violence happens.
>> We can respond to violence right after it occurs, such as providing treatment
for an injury that resulted from violence.
>> A connected notecard reads, secondary
and tertiary prevention equal after violence happens.
>> Or we can provide long term services to help people deal
with the trauma of experiencing violence.
Secondary and tertiary prevention efforts both address violence after it happens.
When we talk about primary prevention, we recall a most fitting and enlightening poem written
in the late 1800s by Joseph Malins entitled "A Fence or an Ambulance."
Let's take a look.
>> On the movie screen, a brown leaf swirls up, then settles beneath old fashioned text.
A Fence or an Ambulance, a story of prevention, by Joseph Malins, 1895.
In black and white, geometric rocks surge upward into the shape of a sheer cliff.
Words appear as the narrator reads them aloud.
>> It was a dangerous cliff, they freely confessed.
Though to walk near its edge was quite pleasant.
>> The view shows a distant craggy hill bathed in pale orange light.
Clouds swell up, obscuring the screen.
>> But over had had slipped a duke and many a peasant.
The people said something would have to be done, but their thoughts did not at all tally.
Some said, a fence for the edge.
>> Geometric shapes fall into place to depict crowds of people facing off.
>> And some, an ambulance down in the valley.
But the cry for the ambulance carried the day.
>> A man passes a white case to a doctor in the back
of a horse drawn wagon marked with white crosses.
>> With hearts full of pity, they gave pence and penny, not for a fence,
but for an ambulance in the valley.
>> A little girl watches the brown leaf twirl to the ground.
The view from the cliff appears.
Then is replaced by the text of the poem.
>> So, day after day, these mishaps continued.
And swift as they were, the ambulance to send, the falls remained without end.
>> A jumble of shapes forms into the outline of a man with a white beard and mustache.
>> Then a wise sage remarked, so strange that we heal when we could prevent.
Let us stop this mischief at its source, he cried.
If the cliff we will fence, then the ambulance no longer needs sent.
>> The crowd of geometric shapes pops up, with a hand pointing a finger at the sage.
Others, again, scoffed.
>> Why should people have of sense drift to a fence when an ambulance is so swift?
>> A man with glasses appears beside a dark haired man with a beard.
>> But a sensible few, who are practical too, will not bear with this nonsense much longer.
They believe prevention is better than cure, and their party will soon be the stronger.
>> A hand moves a toolbox off a paper that reads prevention plan above a diagram of a fence.
>> Better to close the source of temptation and crime than fill the dungeon and galley.
>> Tall trees fill a forest.
The leaf blows past, revealing the little girl leaning on a tall wooden fence
and looking out over the cliff's edge.
>> Better to put a strong fence around the top of the cliff
than an ambulance down in the valley.
>> Clouds curl around the distant view of craggy hills
as the pale orange light glows behind them.
The narrator walks between cars parked at the drive in.
>> In "The Fence or the Ambulance," we are shown how timing
of prevention may yield different results.
The town's decision to use an ambulance is an example of a secondary means of prevention,
which is action taken after the problem has occurred.
While this is an effective means to save the lives of those who have fallen,
it does nothing to stop the falls from happening in the first place.
Ultimately, it is only through an act of primary prevention,
which in this case would have been putting up a face,
that the root of the problem can be addressed.
By acting before people fall, lives are saved before they are put in danger.
Without the fence, the town will continue to be stuck in an endless cycle of reacting
to falls instead of preventing them.
The question, why only focus on healing when we could prevent, is one that very much applies
to violence today, a foreshadowing of sorts on best practices for violence prevention.
>> An interview plays on the silver screen.
Thomas R. Simon, Ph.D., Centers for Disease Control and Prevention.
>> At the CDC, we focus on primary prevention of violence,
which is addressing the problem before it happens.
>> Preventing violence requires extensive research, planning, development, and evaluation.
And if these continuous efforts result in preventing acts of violence,
we're on our way to breaking the cycle of violent behavior in this country.
>> An interview appears on the giant screen behind her.
Rodney Hammond, Ph.D., retired, Centers for Disease Control and Prevention.
>> Not only do you need to put programs in place, but you need to help communities
and neighborhoods organize in ways that they can prevent violence
and make their communities safe.
And the evidence is extraordinarily promising there.
>> The screen flickers and the interview is replaced by one with Brad Perry, MA,
Virginia Sexual and Domestic Violence Action Alliance.
>> Going beyond just keeping the bad stuff from happening, but creating something
that is actually bigger and positive.
>> Rebecca Campbell, Ph.D., Michigan State University.
>> Promoting the positive messages, to treat people with respect, to use your words,
not your bodies, to resolve conflict.
>> When thinking about violence prevention, it is important to implement programs, practices,
and policies that are based on the best available evidence.
In other words, they have been evaluated and shown to reduce violence or the factors
that increase risk, or increase factors that protect people from violence.
With limited time and resources to achieve results, it's critical to spend time
on solutions that have demonstrated success in similar communities facing similar issues.
>> Thomas R. Simon, Ph.D., Centers for Disease Control and Prevention.
>> Look at the evidence base from prevention programs that have been implemented elsewhere,
you know, and think through, okay, this program was effective in that population,
and that population is very like the group of people that I work with,
and so there's a good chance that if I do it in the same way,
I'll see some of those same benefits here.
>> You can learn more about evidence and evaluation with VetoViolence resources.
>> A notecard shows a graduation cap with balloons.
Text on it reads understanding evidence, and EvaluACTION, putting evaluation to work.
>> CDC has also developed a suite of technical packages to help states
and communities take advantage of the best available evidence to prevent violence.
>> And attached notecard reads, violence prevention in practice.
>> Now, let's review some important lessons in violence prevention.
>> A dangling notecard reads, please click the continue button below to proceed.
A yellow arrow points to the bottom right corner of the screen.
[ Music ]