>> We've just seen how violence is a part of leach 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.
>> Violence isn't something that just happens and they 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.
We can respond to violence right after it occurs, such as providing treatment
for an injury that resulted from violence, 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.
>> It was a dangerous cliff, they freely confessed.
Though to walk near its edge was quite pleasant.
But over 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!"
and some, "An ambulance down in the valley."
But the cry for the ambulance carried the day.
With hearts full of pity they gave pence and penny, not for a fence,
but for an ambulance in the valley.
So day after day these mishaps continued and swift as they were,
the ambulance to send, the falls remained without end.
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
than the ambulance no longer needs sent."
Others again scoffed.
"Why should people of sense drift to a fence, when an ambulance is so swift?"
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.
Better to close the source of temptation and crime than fill the dungeon and galley.
Better to put a strong fence around the top of the cliff, than an ambulance down in the valley.
>> 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 as 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 fence
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.
>> 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.
>> 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 community safe.
And the evidence is extraordinarily promising there.
>> Going beyond just keeping the bad stuff from happening but creating something
that is actually bigger and positive.
>> 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 polices 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.
>> Look at the evidence base from prevention programs that have been implemented elsewhere
and you know think through, OK this program was effective in that population
and that population is very like the group of people that work with
and so there's a good chance that if I do it in the same way,
I'll see some of the same benefits here.
>> You can learn more about evidence and evaluation with VetoViolence resources.
CDC has also developed a suite of technical packages to help states
and communities take advantage of the best available evidence to prevent violence.
Now let's review some important lessons in violence prevention.
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