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New strategy added: Assuring access to quality health care

The Spectrum of Prevention

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The Spectrum of Prevention is a broad framework that includes seven strategies designed to address complex, significant public health problems. These strategies take into account the multiple determinants of community health and can be used to develop a comprehensive approach to current public health issues. While many of these strategies are familiar to public health practitioners, when considered as parts of a single approach they become an effective framework for planning public health interventions and coordinating the activities of multiple programs or agencies. The Spectrum of Prevention is not a new approach to public health, rather it is a framework that reminds us that difficult public health problems require a broad range of efforts. It is a guideline, and while not all of the strategies will be appropriate for every issue, the Spectrum provides a reminder that complex problems often require a range of approaches.

The following strategies, or bands, are included in the Spectrum of Prevention:

Influencing policy and legislation
Mobilizing neighborhoods and communities
Changing organizational practices
Fostering coalitions and networks
Educating providers
Promoting community education
Strengthening individual knowledge and skills
Assuring access to quality health care

For examples of each strategy, read The New Spectrum of Prevention: A Model for Public Health Practice.

How the Spectrum is Used

At Contra Costa Health Services, a county health department in California, the Spectrum of Prevention has been useful:

In planning programs to address traditional public health issues such as communicable disease and infant mortality.
In addressing emerging public health problems.
As a structure to consider a range of efforts to approach a single issue.
As a tool for improving coordination and collaboration among different agencies and among programs within large institutions.
To help coordinate the efforts of different groups working on the same issue by providing a framework and common language for people from diverse backgrounds to come together, share information, highlight gaps in service, and develop joint plans to achieve public health outcomes.
To help facilitate partnerships with community groups by illustrating that short-term, seemingly free-standing activities are connected and part of a broader context.

Adapting the Spectrum

Since the Spectrum of Prevention is a flexible model, organizations working in the field of public health and adapting the model based on their own experiences, successes, and failures may make valuable modifications to it. We encourage community residents, networks, coalitions, public health agencies and others to use and adapt the Spectrum to plan and implement their prevention efforts and to share their successes and insights. Let us know how you adapted it by emailing trattray@hsd.cccounty.us.

Definition of the Spectrum of Prevention Strategies

Influencing Policy and Legislation

Legislation and other policy initiatives have proven to be among the most effective strategies for achieving broad public health goals. Both formal and informal policies have the ability to affect large numbers of people by improving the environments in which they live and work, encouraging people to lead healthy lifestyles, and providing for consumer protections.

Mobilizing Neighborhoods and Communities

In the arena of public health, community mobilization is a relatively young concept. Traditionally, public health activities have been performed in a medical model, with the provider-expert at the center, delivering services to individuals. Addressing today's public health problems, however, requires a community as well as a medical approach. It is not effective for a public health professional to enter low-income neighborhoods and lecture residents to stop smoking and eat five-a-day servings of vegetables to reduce their risk of cancer or heart disease. These messages fail to capture the interest of communities confronting more urgent concerns of violence, drug use, unemployment, and the struggle to keep families together. Instead, health departments must be willing to meet with communities and share the agenda, prioritizing community concerns as well as health department goals.

Changing Organizational Practices

Changing organizational practices involves modifying the internal policies and practices of agencies and institutions. This can result in improved health and safety for staff of the organization, better services for clients, and a healthier community environment. Advocating for organizational change at agencies such as law enforcement, schools and health departments can result in a broad impact on community health.

Fostering Coalitions and Networks

Coalitions and networks, composed of community organizations, policy makers, businesses, health providers and community residents working together, can be powerful advocates for legislation and organizational change. Coalitions and networks also provide an opportunity for joint planning, system-wide problem solving and collaborative policy development to ensure that the voices of all community sectors are represented in public health prevention programs.

Educating Providers

This strategy reaches an influential group of individuals "in and out of the health field" who have daily contact with large numbers of people at high risk for injury and disease. By educating providers to identify and intervene in public health issues, professionals, paraprofessionals and community activists working with the public can become front-line advocates for public health. Providers can encourage adoption of healthy behaviors, screen for health risks, contribute to community education, and advocate for policies and legislation.

Promoting Community Education

The goals of community education are to reach the greatest number of individuals possible with health education messages, as well as to build a critical mass of people who will become involved in improving community health. Media advocacy " the use of mass media to shape the public's understanding of health issues " is an important part of community education campaigns.

Strengthening Individual Knowledge and Skills

This band of the Spectrum represents a classic approach of public health. Public health nurses, health educators and trained community members work directly with clients in the home, community settings or in clinics, providing health information to promote child and family health. Some also work with seniors to maintain well-being and independence. Another part of strengthening individual knowledge and skills involves building the capacity of community members to use new approaches and to educate other individuals in their communities. Some health educators work with both youth and adults to build their capacity in areas such as media advocacy, community mobilizing, and working with policy makers to make positives changes in the health of their communities. Residents are encouraged to become more active advocates for community health concerns, get involved in local policy issues, or press for organizational change.

Assuring Access to Quality Health Care

Assuring Access To Quality Health Care

Contra Costa Health Services added the strategy "mobilizing communities" to the Spectrum of Prevention nearly a decade ago to acknowledge the importance of community engagement and partnership with empowered communities. As we have used this new framework, focusing on today's health problems of heart disease, cancer, stroke, diabetes and other chronic diseases, we have realized the New Spectrum of Prevention is incomplete. Now we add this newest strategy—Assuring Access to Quality Health Care—to acknowledge that access to quality health care is critical for prevention, just as access to healthy food and safe places to exercise help to prevent chronic disease. To preview what will be included in the next edition of The Spectrum of Prevention, read Assuring Access to Quality Health Care.

History

In 1982 Contra Costa Health Services formed the Prevention Program. Larry Cohen, then Director of the Prevention Program, developed a framework, based on the work of Dr. Marshall Swift, for designing and implementing primary prevention programs. The resulting Spectrum of Prevention emphasized the importance of approaching public health prevention issues on several levels. In 1996, Contra Costa Health Services Public Health Division merged a number of prevention programs to create the Community Wellness & Prevention Program (CW&PP). Based on experience with new public health issues and strategies, the Public Health Division added a band for mobilizing neighborhoods and communities and renamed the framework The New Spectrum of Prevention: A Model for Public Health Practice.

Do you have an example of how your organization used the Spectrum of Prevention? Share your story with us by emailing trattray@hsd.cccounty.us.