The lack of preparation in advance of COVID-19 cases in the United States has left hospitals, schools and commnunities struggling to find effective medical, educational and social solutions to combating the virus.
Early warnings from China and other Asian countries foreshadowed the serious nature of a virus that knows no physical boundaries. Many public health officials now acknowledge that these initial warnings were largely unheeded.
Rather than implementing preventive strategies to reduce the virus, elected officials and policymakers chose a “wait-and-see” approach.
The national response to the spread of COVID-19 illustrates a larger and more serious flaw in our nation’s approach to ensuring the well-being of children, youth and families — namely, the lack of a federal strategy to prevent health problems before they occur or become widely prevalent.
The absence of a health-focused national prevention strategy extends beyond problems associated with reducing medical illness and disease.
Indeed, the lack of current preventive efforts to stop the COVID-19 virus is strikingly similar to the country’s fragmented approach to preventing behavioral health problems like anxiety and depression; alcohol, tobacco and other drug abuse; aggression and violence; school dropout; and risky sexual activity. These problems exact significant individual, social and economic costs on millions of young people in the United States each year.
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The annual financial fallout associated with adverse behavioral health outcomes is in the billions of dollars. Other costs are incalculable, as parents, teachers, human service professionals and communities struggle to combat the effects of individual suffering, lost potential and fraying social conditions.
Behavioral health problems also reflect and perpetuate social inequities. Like the current racial and ethnic disparities being reported in cases of COVID-19, different societal groups experience dramatically different levels of behavioral health problems.
The absence of a national health and behavioral health prevention strategy is inconsistent with evidence pointing to the power of prevention in reducing the prevalence of medical and behavioral health problems. Public health experts have long recognized the value of identifying the individual and environmental characteristics, conditions and behaviors that predict or protect people from illness and disease.
For example, successful national campaigns to inform the public of risks for and protective factors against cardiovascular disease have led to considerable reductions in cardiovascular risk factors such as smoking. Identifying risks for and protective factors against health problems such as diabetes has helped countless individuals prevent, detect or manage their diseases.
A public health approach based on identifying risk and protective factors for illness and disease has also been used to effectively prevent child and adolescent behavioral health problems.
Today, more than 65 effective individual, family, school and community prevention programs for behavioral health problems have been identified. Many programs teach young people social, emotional and behavioral skills necessary to make good decisions and live healthy lives.
Other programs help parents develop the skills they need to raise their children; some parenting programs are located in primary care settings. And, still others work at a broad level to involve citizens and community leaders to identify and select programs and policies that best fit the needs of their communities.
Prevention deserves a more prominent role in federal efforts to combat health and behavioral health problems. Current national prevention policy and program initiatives are underfunded and fragmented across departments.
Consequently, the complex tasks of creating and operationalizing prevention initiatives have been left largely to individual states. Some states have made impressive progress in advancing prevention despite a lack of federal direction.
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In Colorado, the Department of Human Services, Office of Behavioral Plan collaborated with members of the Coalition for the Promotion of Behavioral Health to create a statwide strategic plan for the primary prevention of substance abuse and other behavioral health problems.
The plan uses evidence from prevention science to help communities and service providers select evidence-based policies and programs that are known to be effective in reducing behavioral health problems. Similar efforts are underway in Massachusetts and Utah.
Evidence derived from public health approaches to reducing medical and behavioral health problems is clear and compelling. We can reduce population-level rates of illness and disease and prevent poor behavioral health outcomes in people of all ages.
To do so, we must develop a national, coordinated prevention strategy that calls for the implementation of effective programs and policies in medical, family, school and community settings.
A national office charged with promoting and funding effective health and behavioral health prevention directives would serve as an important conduit to states and communities struggling to reduce health and behavioral health problems. Now is the time to expand the important role that prevention plays in ensuring the well-being of all citizens.
Jeffrey M. Jenson is a professor at the University of Denver’s Graduate School of Social Work and is chair of the Coalition for the Promotion of Behavioral Health.
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