Larry Cohen Reflects on a Career in Public Health and the Future of Prevention

October 11, 2018 | ASTHO Staff

You retire as executive director of the Prevention Institute in October. What have been the organization’s top achievements during your tenure? 

We all know—and also easily forget—the importance of health and well-being. When we or our families, friends, or colleagues face setbacks and tragedies, we remember that nothing matters more than health and we would do anything to reduce or reverse the impacts of illness and injury. Yet we so often fail to take steps in the first place to keep us healthy and safe. The Prevention Institute’s goal is to put prevention more fully on the map—to establish a way of thinking, a way of working, and most importantly, a way of supporting our communities to become healthier. We have to intentionally work towards equity—to ensure that all communities have access to health and remember that everyone has the right to health, safety, and well-being. So as prevention strategy is created, it must focus on the people and places with the greatest need.

In almost every case, we have proudly accomplished our achievements with partners. We have focused on the environment as the primary shaper of health outcomes and developed the notion of “community determinants.” We have also helped shift from health as just meaning healthcare after the fact to meaning health in the first place. In addition, we have created a number of tools to help local and national partners achieve these goals more successfully. I hope our efforts have made the Prevention Institute the go-to organization for those seeking inspiration and specific approaches to carry out the work of prevention. 

Given your experience leading the Prevention Institute, what advice do you have for public health leaders looking to advance prevention and health equity in their communities?

Despite the pressures to compete, we all need to work together and build on one another’s efforts. The kind of work we can and must accomplish is substantial and we are coming toward a time of local and national opportunity where new ideas and new approaches will be seen as essential. While right now the national climate has slowed some innovation, we must advance emerging opportunities in terms of community-level action and leadership. Public health must be ready to help lead and facilitate transformation. Every public health department in every community is needed to advance future prevention innovation. 

To accomplish this, we must intentionally de-silo to address the intersection of health issues and also engage every sector that influences health and equity. Health, well-being, and safety can and should be collectively advanced. Working together on these important issues creates co-benefits for business, healthcare, schools, local government, etc. Public health also understands and must continue to advocate the value of comprehensive approaches to community-level, institution-level, and policy-level change. Shifting norms towards prevention as a core solution to health and wellness, we should highlight evidence-based practices from around the country. Public health must embrace that not only is it within its purview to advance policy needs, but public health and equity work cannot be effective without shifts in policy. 

For example, an opportunity we must seize is transition in the healthcare system. Healthcare hasn’t traditionally been extensively involved in population health. However, over the past decade or so, we’ve seen interest expanding and ideas like social determinants entering their terminology. We must capitalize on that interest and help direct the credibility, values, and resources that healthcare represents toward community-wide health and greater support for public health efforts. 

What do you consider the most immediate opportunities for public health leaders to raise awareness around community resilience?

In all of our work we must move away from just addressing crises to focusing on building resilience and community well-being. There are opportunities emerging right now to address critical issues related to mental health, addiction, trauma, and the importance of well-being. We know that addiction and trauma thrive when people and communities are suffering. In fact, many communities who have withstood long-term inequities in health and well-being are currently facing increased trauma. In the last few years, understanding of adverse childhood experiences has brought new attention to the role of trauma in health outcomes. Public health is situated to lead the way in moving from a focus on individual trauma to addressing adverse community experiences and the community determinants that lead to addiction and diseases of despair. We need to rethink narrow approaches. Communities are developing multi-sectoral and culturally responsive strategies. To truly improve community resilience, public health must build on existing community assets and leadership and help shift towards policies and practices that support community well-being and positive norms.