A good solution solves multiple problems

LARRY COHEN, CAROLINA GUZMÁN, SANA CHEHIMI and ANNA REALINI

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SHIFTING the global dependence on fossil fuel based transportation towards healthier and alternative modes of transport – walking, bicycling, and public transit – is a central strategy in the mitigation of climate change. To maximize use of active transportation, it is necessary to make people feel safe while walking, biking, and using public transit. Thus, it is critical to focus on strategies to make communities and transportation safer.

Our research shows that efforts to improve neighbourhood design in order to facilitate walking and bicycling and the use of public transit are less effective when fear and violence pervade the environment.1 Newly emerging research confirms that the presence or fear of violence impedes activity levels and the ability to move outside freely, especially among populations that are more vulnerable to violence such as children, women, people with disabilities, and older adults. For example, surveys in the United States show that the number of people who would walk and bike would double if people felt safe.

The fear of community violence has increased automobile usage by those who can afford it for day-to-day living activities in virtually every country worldwide. This increase in driving contributes to CO2 emissions and exacts a terrible immediate air quality burden on young people and communities throughout the world. Though the dependency on automobile transportation is pronounced in affluent communities and high income countries (HIC), the resulting climate change disproportionately impacts economically distressed communities and low and middle income countries (LMIC).

The good news is that evidence shows that violence is preventable. Many of the same types of efforts that have worked for unintentional injury prevention – addressing the underlying conditions in community environments, shifting related norms, and reconsidering community design – can also be applied to preventing violence. Expanding current injury prevention efforts to include a focus on the prevention of violence is a critical step in improving the health of our environment and our communities. Reduction of violence requires comprehensive approaches and multiple sectors working together. When these efforts are undertaken, safety is enhanced, active transportation encouraged, and climate change minimized.

The transportation sector, including personal vehicles, is a major and increasing contributor towards greenhouse gas emissions worldwide, mostly in the form of CO2. In a study that reviewed modes of transportation in many HICs, walking and bicycling levels were found to roughly correlate in an inverse fashion with auto usage. For example, automobile use for all trips in urban areas in Europe, North America and Australia ranged from a low of 36% in Sweden to a high of 84% in the United States. In Sweden, the Netherlands, Switzerland, Denmark, Italy, and Austria – countries with infrastructure to support active transportation – the modal share of trips taken by walking and bicycling was at or above 40%, while the share occupied by the auto was near or below 40%. Conversely, in high auto usage countries such as the United States, Great Britain, and Canada, the percentage of walking and bicycling trips was below 20%, and among these, the United States ranks last, with walking and biking accounting for only about 10% of all trips (compared to automobile use at 84%).

 

This reliance on automotive transportation has many direct health consequences, including steep declines in physical activity and the associated rise in chronic illness, as well as an increase in pollution related diseases such as asthma, impaired lung development and function in infants and children, and increased incidence of lung cancer, heart disease, and respiratory illness. Long-term exposure to pollution from traffic may be as significant a threat for premature death as traffic crashes and eating and activity related chronic disease. Further, the conviction that autos are necessary contributes to the belief that an expansion of fossil fuel sources is essential.

While car ownership rates are lower in less motorized countries, fear of violence can increase the frequency of auto use in two ways. Short-term, the fear or presence of violence can result in people taking additional auto trips when they might otherwise walk, bike or take public transit. Second, long-term fear of violence can lead to housing patterns where wealthier residents choose to live many miles away from urban centres, cementing and exacerbating the car use patterns. These newly developed extra-urban communities are often designed without social and business centres, promoting sprawl and automobile use. Reducing violence and changing the perception of violence is necessary to reintegrate and restore thriving cities that support active transport. While there are clearly many reasons for auto use besides safety and improving safety alone will not dramatically reverse the predicted growth of car usage, safety does remain one of a number of factors that together reinforce car usage patterns and norms.

The relationship between land use development, vehicle travel distances, and the carbon dioxide emitted by vehicles jointly impacts people’s ability to engage in physical activity and contributes to global warming.2 Part of the solution to the crisis of climate change – in the context of the built environment – is designing communities in a way that reduces sprawl and improves transportation systems to include more safe and inviting opportunities for walking, bicycling, and using public transit.3

 

To better understand how to effectively increase safety, promote active transport, and reduce climate change, it is important to identify the pathways through which violence negatively influences the likelihood and levels of walking and biking as a main mode of transportation. Prevention Institute’s paper, ‘Addressing the Intersection: Preventing Violence and Promoting Healthy Eating and Active Living’, describes these intersections, primarily in the United States, and emphasizes the value of comprehensive, cross-sectoral solutions.

Of course, community and interpersonal violence jeopardize health and safety directly – causing injuries, death, and emotional trauma. Additionally, witnessing or directly experiencing violence, as well as the fear of violence, contribute to unhealthy behaviour and impact people’s choices, including where they live, work, and shop; if they feel safe to be active outside; and whether they use public transportation. Safety concerns also particularly affect parents’ decisions, including whether children are allowed to play and bike outside or walk to school. In some studies, researchers have found that urban parents were much more concerned about their children’s safety than suburban parents and that parental anxiety was negatively associated with children’s physical activity.

 

This fear of violence also permeates how children experience their daily lives at large. For example, those who are scared at school prioritize safety over learning. Also, if there are no safe places to play, children are more likely to have a sedentary lifestyle – they are less likely to travel and gather for play, reducing social interaction and also reducing their exposure to bicycling or walking as a mode of daily transportation. According to a study of physical activity levels in Canada, ‘feeling safe had the largest potential effect on a population’s levels of physical activity.’ Furthermore, ‘strategies to increase physical activity in the population need to consider the wider determinants of health related behaviour, including fear of crime and safety.’ In one study, people who classified their neighbourhood as ‘not at all safe’ were three times more likely to be physically inactive during leisure time than those who considered their neighbourhood to be ‘extremely safe’.4

Violence and activity related chronic diseases are most pervasive in historically disenfranchised communities – occurring more frequently and with greater severity, making them fundamental equity issues. These inequalities result from systematic, historic policies and practices that disadvantage certain populations. Inequality is often a result of institutional and government policies. Efforts to improve safety must address the underlying conditions and related community conditions as a key element of the solution.

 

Within the United States, Prevention Institute’s UNITY initiative – funded by the U.S. Centers for Disease Control and Prevention and a member of VPA – builds support for effective, sustainable efforts to prevent violence before it occurs, so that urban youth can thrive in safe environments with ample opportunities and supportive relationships. UNITY coordinates the UNITY City Network, a growing number of U.S. cities committed to preventing violence before it occurs through a public health approach; guides effective and sustainable practice through tools, training and technical assistance; makes the case for including prevention in urban efforts to address violence; and educates decision makers and informs national strategies.

In 2006, UNITY conducted the ‘Assessment of Youth Violence Prevention Activities in USA Cities.’5 Researchers conducted interviews with mayors, police chiefs, school superintendents and public health directors in one third of the largest U.S. cities. The assessment revealed that violence was a major concern; law enforcement and criminal justice were the most prevalent strategy used to address it; responses were not perceived to be highly effective or adequate; most cities lacked a comprehensive strategy; few cities reported using primary prevention to stop violence before it occurs; and informants lacked a shared knowledge of existing youth violence prevention resources available in their cities. Significantly, in a comparison of violence rates to informant responses, cities with the greatest coordinated approach also had the lowest rates of youth violence.

UNITY RoadMap

Who? Partnerships

1. High-level leadership: The mayor and other local leaders insist that the violence stops, provide necessary supports and resources, and hold people accountable.

2. Collaboration and staffing: There is a formal structure for multidisciplinary collaboration to coordinate priorities and actions across multiple jurisdictions and there is dedicated staffing in place to support collaboration and implement priorities.

3. Community engagement: Members of the community – youth and adults, community based organizations, the faith community, the business sector, and survivors – are actively engaged in setting priorities and ongoing activities.

What? Prevention

4. Programmes, organization practices and policies: There are effective and far-reaching efforts in place to prevent violence, particularly in highly impacted neighbourhoods.

5. Training and capacity building: Participants, practitioners, and policy makers have the skills and capacities necessary to work across multiple disciplines and in partnership with community to implement effective prevention programmes, policies, and practices.

6. Communication: The case has been made for preventing violence before it occurs and people are aware of what’s being done to prevent it.

How? Strategy

7. Strategic plan: There is a plan in place that prioritizes prevention, is well-known, and informs priorities and actions for multiple departments, agencies, jurisdictions, and community groups.

8. Date and evaluation: Efforts are informed by data and continuously improved through ongoing evaluation.

9. Funding: Adequate resources support collaboration and staffing; community engagement; the implementation of programmes, policies, and practices; skills development and capacity building; communications; strategic planning; and data and evaluation.

In response to these findings, UNITY developed The UNITY Road-Map in partnership with city representatives and advisors from across the United States. Building on available research, the UNITY RoadMap is a framework for understanding the key elements needed to prevent violence before it occurs and to sustain these efforts in cities. It builds on similar tools that have been effective for other challenging issues that were similar in their complexity. Many of the categories were drawn from the AIDS Programme Efforts Index (API) developed by The POLICY Project, USAID and UNAIDS to measure the effort put into national HIV/AIDS programmes throughout the world. The UNITY RoadMap is organized into three categories – partnerships, prevention and strategy – and features nine key elements.

 

A five year evaluation conducted in 2010 demonstrated that UNITY shapes the approaches that cities are taking to reduce violence, and increases their focus on prevention.6

The research body that confirms that violence is preventable continues to grow. For example, schools can reduce violence by 15% in as little as six months through universal school based violence prevention efforts. Public health research has documented a 44% reduction in overall crime, including an 18% reduction in violent crimes, in neighbourhoods that created Business Improvement Districts. Also, investing in programmes that engage families in understanding the impact of behaviour on health are helpful in complementing prevention strategies and policies.

 

The Nurse Family Partnership trains public health nurses to make regular home visits to low income, first time mothers to help them reduce the risk of child abuse and unintentional injury. Children who do not participate in this programme are as much as twice as likely to have been arrested by age 15 and a RAND study demonstrated that the programme saves at least $4 for every dollar spent. A similar programme, the Triple P Parenting programme, has demonstrated a $47 benefit to society for every dollar invested in the programme.

Case Study: Violence Prevention at Work

Across the United States, UNITY cities and partners continue to demonstrate that violence is preventable. Minneapolis, Minnesota and Cease Fire Chicago are prime examples. Minneapolis (a member of the UNITY City Network), documented a 40 per cent drop in juvenile crime in its most violent neighbourhoods in just two years after implementing its four-point, public health based approach. Homicides of youth decreased by 77 per cent between 2006 and 2009, and the decline in juvenile crime was accompanied by a decline in arrest rates. The number of youth suspects has dropped by 60 per cent from 2006 to 2010, and the number of youth arrested for violent crime for 2011 is down by one-third of what it was four years ago.

The public health based CeaseFire Chicago (CF) model promotes norms change in communities and has reduced shootings and killings by 41 to 73 per cent and dropped retaliation murder by 100 per cent. Baltimore, Maryland’s CF replication, the Safe Streets programme, not only reduced overall gun violence, but also reduced non-fatal shootings by up to 44 per cent and homicides by up to 56 per cent.7

Violence can be prevented to restore peaceful streets and thriving communities. Free from fear, such community vitality can soar – socially and economically. Instead of residents with economic means looking for every opportunity to flee to distant suburbs, which are perceived to be safe but require an over-reliance on cars, people are drawn to live and work within safe, thriving urban environments which offer access to needed services, businesses, schools, jobs, places of worship, and recreation via a walk, a bike ride, or public transportation. Investment in violence prevention programmes also shows a huge return on investment and decreases the burden on state budgets of spending on healthcare and policing.

 

Changes in the built environment – the ways communities are designed – can have a significant effect on making communities look and feel safer. The built environment refers to everything that we design and construct – including homes, schools, offices, places of worship, theatres, parks, and restaurants, as well as the streets and open spaces that connect these places. Just as the quality of air and water impacts our health, so do our decisions about community design. For example, the location of roadways, the design of our schools, and the distance between workplaces and homes all affect our physical and social well-being. Nevertheless, conventional city planning and automobile focused development by local, regional, and state agencies still generally overlook or undervalue the impact of the built environment on health, safety, equity and climate change.

Case Study: Diadema, Brazil: Providing Land Rights and Reducing Alcohol Abuse

In Diadema, a huge industrial city outside São Paulo, Brazil, 30% of the population lived in favelas during the 1980s, when the homicide rate was rising catastrophically. The government turned to residents for advice, asking them to help set priorities for the city budget, suggest upgrades for neighbourhoods, and approve construction projects, which employed workers who lived in the communities. A land tenure programme awarded residents the right to stay on their property for 90 years, while they were previously treated as squatters. This encouraged them to maintain their homes and invest in the neighbourhoods. Residents helped to widen and pave streets and install clean water and sanitation systems. Today, only 3% of Diadema’s residents live in favelas.

Diadema experienced one of the highest homicide rates in Brazil. Research indicated that 60% of homicides and 45% of complaints about violence against women occurred between 11 p.m. and 6 a.m. in neighbourhoods with a high concentration of bars and were highly associated with alcohol consumption. Using zoning, enforcement (prohibiting the sale of alcohol after 11 p.m.) community education and partnerships with retailers, helped to decrease the violence rates precipitously in these areas of Diadema. The community flourished as it suddenly felt safer. And business opportunities grew, with Diadema leading all of Brazil in new jobs created. The annual homicide rate, a standard measure of civic order and public health, has dropped to 14.3 per 100,000 from its high of 140 during the 1990s. Diadema’s success was copied across Brazil and has been seen as an inspiration to cities around the world, enhancing the understanding of such strategy internationally and elevating the potential for alcohol prevention.

These current planning and development systems create neighbourhoods that are disconnected, fragmented, uninviting, and unsafe. These designs in turn result in communities that rely on automotive transport and lack the infrastructure to support bicycling, walking, and the use of public transportation. Decisions about our neighbourhoods are vital and well considered changes in community design result in improving physical activity, health, safety, equity, and air quality/ climate change.

 

In terms of injury prevention, there has been some attention to changes in the built environment to reduce unintentional injury, such as traffic crashes and falls. Traffic calming, for example, where streets are redesigned to slow traffic and encourage walking and community mingling – bicyclists and pedestrians are separated from automobile drivers, and curves and trees are added to encourage the remaining drivers to drive more slowly – has grown in its recognition and use across the world. However, changes to the design of neighbourhoods in order to reduce violence are implemented far less frequently. Policies must consider the design of communities in order to foster violence-free and vibrant neighbourhoods; effective strategies that reduce perceptions about and fear of violence will reduce the reliance on cars.

For example, well designed and safe streets help develop active, healthy neighbourhoods with greater economic development; zoning policies can help create vital community centres and increase the presence of businesses, thus increasing neighbourhood foot traffic. Placing public transportation where it is equitably responsive to community needs and encourages links to vibrant centres is valuable. Strategically considering what’s sold and how it’s promoted influences community norms and related behaviour. For example, increasing access to healthy food, reducing the availability of firearms, and developing policies that decrease the density of alcohol outlets and advertising in neighbourhoods have been shown to reduce crime.8

 

Policies that address the look and feel of the neighbourhood, and improve beautification also help change perceptions of safety. Street lighting that is designed for pedestrians addresses actual safety concerns, both personal safety and traffic safety, and also increases the perception of safety. Also, it is unappealing to walk by the blank, unfriendly expanses created by windowless structures or by parking lots or garages. ‘Dead spaces’ like these lack visual interest, often feel oppressive to pedestrians, and can encourage crime. Transforming these spaces for community use can significantly improve perceptions of safety as well as opportunities for activity. Adding public art in these spaces (such as sculptures or murals in plazas, parks, or buildings) creates active destinations, gives character to an area, and the pieces can serve as landmarks, helping people find their way. Street furniture (such as benches, drinking fountains, and trash receptacles), is often regarded as an optional amenity, but can contribute markedly to the comfort and character, and thus frequency of use, of an area for pedestrians – thus encouraging public transit, walking, and biking.

 

Efforts to advance new initiatives must engage the leadership and wisdom of the community to achieve success. Photovoice is an example of a non-traditional tool for facilitating community participation and engagement. Through Photovoice projects, residents tell their own stories, which can reveal what is going in the community. In particular, youth have made great strides in enhancing neighbourhood environments by using photographs and videos with accompanying stories to promote a healthier public policy.

Case Study: The Washington, DC, USA, Metro: Design and Management as Components of Violence Prevention in Public Transportation

The DC metro subway system has been heralded as one of the safest public transit systems in the United States. It was deliberately designed with an objective of maximizing safety for its users. The DC metro crime rate has been low since its inception in the 1970s – less than half the rate of comparable systems in similar cities. While almost all transit related crime does not include violence against individuals and is primarily related to the destruction of property, littering, and similar offences, higher crime rates increase the perception of risk of violence and are a deterrent to public transit use. Enhancing the perception of a transit system as safe enhances the likelihood of its use at all hours and also strengthens the impression that it is a well managed system, which further enhances the likelihood of use. The metro benefited from being constructed later than many of the transit systems in the United States, which allowed for the incorporation of smart, crime prevention design and operation features. The stations include a communications system that includes video monitoring, blue light boxes and power-shut down boxes. All graffiti is removed within 24 hours and planners avoided creating dark corners, including avoiding corners in stations at transfer points, where users are more likely to have to change platforms. The metro also has trains running on a strict schedule to minimize the waiting time for passengers and limit the time in which crime can occur.

Regrettably, the metro does not have public restrooms, nor allows eating establishments or other facilities, with the goal that such bans reduce lingering inside the station and thus deter crime and make monitoring the area for safety easier. It is also prohibited to eat or drink in the stations or on the train, which does have the positive affect of making the area cleaner and more sanitary.

For one community pilot project, funded by The Convergence Partnership, a national partnership of leading philanthropy foundations, youth in six neighbourhoods across the United States used Photovoice to make the case for improvements to their neighbourhood environments in order to prevent violence while promoting access to healthy food and opportunities to be active. The Photovoice component of each community’s prevention efforts helped to build the capacity of the youth and mobilized many of the participants to become agents of change beyond the work with the pilot. In addition, the photos and videos stimulated honest discussions with government officials, public and private partners, and other decision makers and moved these stakeholders to action.

For example, the youth working with the Louisville, Kentucky, pilot presented their photos to more than 400 people including district representatives and other decision makers, spurring major street repair and other efforts to remove blight, promote safety, and encourage more walking in their neighbourhood. In western Chula Vista, California, several government agencies attended presentations of the youth’s Photovoice series, which included recommendations for improvements to parks and metro stops. One member of the Chula Vista team remarked, ‘It was their impact, their involvement, the way the youth owned and spoke to the issues… which really made the difference.’

 

Two frameworks to help develop a multifaceted, comprehensive approach to preventing violence and reducing climate change are:

* The Spectrum of Prevention provides a systematic framework for developing effective and sustainable community prevention efforts. It is designed to create initiatives that go ‘beyond brochures’ in order to create comprehensive solutions. The six levels of the Spectrum – (i) strengthening individual knowledge and skills, (ii) promoting community education, (iii) educating providers, (iv) fostering coalitions and networks, (v) changing organizational practices, and (vi) influencing policy and legislation – are complementary and when used together each level reinforces the others, leading to greater effectiveness.

* Collaboration Multiplier is a tool and a process that fosters meaningful and impactful partnerships between diverse sectors to more effectively produce community-wide change. This process helps to delineate the particular skills and niche of different collaborators, suggests what needs to be better understood, and identifies key players that may be missing.

 

Successful prevention initiatives require attention to community conditions in order to determine and implement comprehensive solutions. The Spectrum of Prevention provides a systematic framework for developing effective and sustainable community prevention efforts.

Case Study: Spectrum of Prevention: An International Application, Medellin, Colombia9

An example of the links between the built environment and safety is the case of Medellin, once a world capital of drug cartels, murder, and suffering. Approximately a decade ago, progressive political leaders began to invest most heavily in the worst slums. They built a cable car system to link the city’s centre with the isolated, crime-ridden areas that blanketed the surrounding hills. New libraries, parks, public schools, and pedestrian walkways were built around the pylons of the transport system so that the most beautiful and ambitious public architecture in the city went into the poorest neighbourhoods. Medellin’s communities were drastically improved.

Examples of successful strategies in Medellin at each level of the Spectrum are included below.

Level 1. Strengthening Individual Knowledge and Skills: The first level of the spectrum emphasizes enhancing the skills that are essential to support healthy behaviours. For example, to address the high rates of homicide in Medellin, Colombia, an integrated effort to address safety and civic participation included increased job training and education, and a youth-led programme was developed to educate other youth in conflict resolution.

Level 2. Promoting Community Education: The second level broadens the emphasis to educating groups of people rather than individuals. Too often, health education initiatives focus on brochures or health fairs. While paid advertising is generally not an effective way of improving behaviours, mass media is increasingly becoming the primary vehicle for community education worldwide. Media coverage before, during, and after an event to increase community awareness about prevention can reinforce the prevention message for a larger audience. In this way, media can influence residents’ perspectives as well as help strengthen community support of the policy, increasing community involvement and activism.

 

For example, Medellin publicized its Municipal Development Plan, called Medellin: A Commitment of All Citizens, which emphasized security and peaceful coexistence as the main components. In more direct engagement, over 8,800 neighbourhood assemblies were held to develop the content of the plan, reaching over 66,000 participants. A manual was then formulated on Peaceful Coexistence (popularizing the new Police Code), with the participation of 25,000 people. Ultimately more than half a million citizens participated in events oriented to the socialization of this new instrument.

Level 3. Educating Providers: The third level emphasizes that reaching and educating providers is essential, as they often have influence within their fields of expertise, help shape standards and norms, and serve as conduits to communities and individuals. For efforts related to safety, the term ‘providers’ typically invokes groups such as law enforcement, medical professionals (doctors, nurses, midwives), and teachers. However, by expanding the notion of provider, it is possible to mobilize a broader group in advancing prevention and promoting safety. We must extend beyond the ‘usual suspects’ to anyone who is in a position to share information or influence the opinions of others – for example, municipal staff, designers, architects, employers, and business, labour, and community leaders. In Medellin, given the tremendous mistrust among the population who had suffered from high levels of police brutality and repression at the height of the drug and guerrilla conflict in the area, a key provider effort was the Peace and Reconciliation Programme, which re-socialized demobilized former soldiers of paramilitary groups. This reached over 4,000 direct beneficiaries, who in turn were able to help change military norms, which resulted in increased trust from residents.

Level 4. Fostering Coalitions and Networks: The fourth level of the Spectrum emphasizes that we can accomplish more and have a greater impact working together than working alone. Fostering collaborative approaches brings together the participants necessary to ensure an initiative’s success and increase the ‘critical mass’ behind an effort. Coalitions and expanded partnerships are vital in successful movements including violence prevention and safety promotion. Collaboration is not an outcome per se, like the other levels of the Spectrum, but rather a tool used to achieve an objective. Often the best way to ensure a comprehensive strategy is to build a diverse coalition. Collaborations may take place at several levels: at the community level, including grassroots partners working together such as in community organizing; at the organizational level, including nonprofit/non-governmental organizations working together to coordinate the efforts of business, faith, and other interest groups; and at the governmental level, with different sectors of government linking with one another. Medellin’s Participatory Budgeting Component (PBC) has accomplished many of the initiatives described in this Spectrum example, and it derives much of its strength from the coalition partners. Through its coalition and networks, the PBC implemented more than 2,700 projects supported by more than $192 billion Colombian pesos (approx. USD 95 million). 6,600 neighbourhood assemblies played a key role in shaping these efforts, along with the newly established communal councils.

Level 5. Changing Organizational Practices: The fifth level focuses on reshaping the general practices of organizations and institutions, which affect both health and norms. For example, changes to internal practices impact the members, clients, and employees of an institution, and changes to hiring and contracting practices, the design and development of products, marketing practices, and practices regarding energy use and waste disposal impact the surrounding community and serve as a model for all. Changing organizational practices is more easily achievable in many cases than policy change and can become the testing ground for policy.

 

Government and health institutions are key places to make change because of their role as standard setters. Other critical arenas include workplaces, media, business, sports, faith organizations, and schools. For example, to address issues of neighbourhood level violence, the city of Medellin implemented an equity focused planning process whereby housing improvement and hazard mitigations processes were institutionalized within the housing agency so as to promote pride and a sense of ownership among residents. Further, inter-sectoral efforts to promote economic development were undertaken – and the Medellin area now reflects a growing economy: 300 new businesses opened in the most high-need neighbourhoods.

Level 6. Influencing Policy and Legislation: The sixth level of the spectrum has the potential for achieving the broadest impact across a community. Policy is a set of rules that guide the activities of all members of society. By mandating what is expected and required, sound policies can lead to widespread behaviour change on a community wide scale that may ultimately become the social norm.

 

Over the course of the past decades, examples of improvements in health and safety that have occurred as a result of policy change, include: a reduction in diseases due to laws outlawing cigarette smoking; a decrease in workplace and roadway crashes due to dramatically greater use of safety equipment; reductions in lead poisoning due to restrictions on lead use; and reduction in violence, chronic disease, and climate change due to policies that support safe environments include zoning laws that promote compact design with emphasis on walkability and transit opportunities.

In Colombia, a set of laws and policies were adopted, including the Law on Urban Reform in 1989, the Law on Social Housing in 1991, and the Municipal Development Plans and Public Services Acts in 1994, which together were conducive for the adoption of municipal efforts to promote safety and well-being. As a result, Medellin developed five new park libraries in areas with the highest needs. These libraries promote cultural and civic encounters and are equipped with 539 computers. A new 15,000 square metre cultural complex was also built, which is visited by 400,000 people per year.

Globally, we are all affected by violence, poor air quality, and by the ever increasing impacts of climate change. However, these impacts are disproportionately felt by disenfranchised and under-resourced communities who nearly always suffer the most and bear the greatest burden in health and safety outcomes and have the fewest resources to respond to these mounting challenges. This is exacerbated by the cycle that is created as changes in weather patterns due to climate change intensify the conditions that lead to civil conflict. Effectively promoting safety through the built environment is necessary to stop this cycle and reduce injuries and death, and also to encourage physical activity, increase transportation accessibility, improve air quality, and mitigate the impacts of climate change.

 

Complex health, social, and environmental issues require quality prevention approaches based on a new way of thinking that examine underlying causes and develop multifaceted strategies and partnerships. Violence is preventable if it is approached with commitment and sustained attention. Any one group, organization, or field cannot prevent violence in isolation. It requires coordinated and comprehensive efforts and resources, and the active cooperation of sectors and fields that might not typically work together. It is time to seize the opportunity to work collaboratively, building on what we know can work.

Addressing violence prevention has many benefits. It’s good for community well-being, good for business, good for equity, good for education, good for physical activity and transit, and good for climate change. It is indeed a good solution that solves multiple problems.

 

Footnotes:

1. D. Berrigan and R.P. Troiano, ‘The Association Between Urban Form and Physical Activity in U.S. Adults’, American Journal of Preventive Medicine 23(2), supplement 1, 2002, pp. 74-79.

2. R. Ewing, et al., Growing Cooler: The Evidence on Urban Development and Climate Change. Urban Land Institute, Washington, D.C., 2007.

3. Prevention Institute, Strategies for Enhancing the Built Environment to Support Healthy Eating and Active Living. Prevention Institute, Oakland, 2008.

4. D.K. Wilson, et al., ‘Socioeconomic Status and Perceptions of Access and Safety for Physical Activity’, Annals of Behavioral Medicine 28(1), 2004, pp. 20-28.

5. B. Weiss, An Assessment of Youth Violence Prevention Activities in USA Cities, 2008. [online] Oakland: Prevention Institute. Available at <http://www.preventioninstitute.org/component/jlibrary/article/id-137/127.html>

6. Prevention Institute, Urban Networks to Increase Thriving Youth Through Violence Prevention (UNITY) 2010: FOA 05042 Final Project Report, 2010. [online]. Available at <http://www.preventioninstitute.org/unity>

7. D.W. Webster, et al., Evaluation of Baltimore’s Safe Streets Program: Effects on Attitudes, Participants’ Experiences, and Gun Violence, Final Report. Johns Hopkins Center for the Prevention of Youth Violence, Johns Hopkins Bloomberg School of Public Health, Baltimore, 2011.

8. S. Duailibi et al., ‘The Effect of Restricting Opening Hours on Alcohol-related Violence’, American Journal of Public Health 97, 2007, pp. 2276-2280.

9. V.A. Vargas and P.V. García, Violencia urbana, seguridad ciudadana y políticas públicas: la reducción de la violencia en las ciudades de Bogota y Medellin (Colombia) 1991-2007. Universidad Nacional de Colombia, Bogota, 2008.

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