National Center for Injury Prevention and Control

Division of Violence Prevention

CS221239B

The Public Health Approach 

to Violence Prevention

The public health perspective asks the foundational questions: Where does the problem begin? How could we 

prevent it from occurring in the first place? To answer these questions, public health uses a systematic, scientific 

approach for understanding and preventing violence1

. While violence prevention practitioners may not be involved in 

all steps, understanding each step and why they are necessary to assure the desired impact on community health

is helpful in selecting and/or developing prevention strategies. 

The Public Health Approach 

There are multiple steps in the public health approach, with each step informing the next. Many people, 

organizations, and systems are involved at each step along the way. Think of it as a relay team for prevention. 

The prevention practitioner usually takes up the baton in the fourth step, but overall success depends upon all of

the other teammates and how they run their legs of the race

The Public Health Approach

In step one, the problem is defined. This involves 

systematically collecting data to determine the 

“who”, “what, “where,” “when,” and “how.” Data 

are typically gathered from a variety of sources 

such as death certificates, medical or coroner 

reports, hospital records, child welfare records, law 

enforcement or other records. Data can also be 

collected using population-based surveys or other 

methods. 

In step two, the reasons why one person or 

community experiences violence while another 

does not are explored. Scientific research methods 

are used to identify the factors that increase the 

risk for violence (risk factors). Factors that may 

buffer against these risk factors are also identified; 

these protective factors decrease the likelihood of 

violence in the face of risk. The goal of violence prevention is to decrease risk factors and increase protective factors.

In step three, prevention strategies are developed and rigorously tested to see if they prevent violence. 

This information is shared with others, usually through activities related to step four.

Step four is where the rubber meets the road. The strategies shown to be effective in step three are disseminated 

and implemented broadly. While many prevention practitioners may not have the skills or resources necessary to 

conduct steps one, two, and three, knowing where to look for the findings of others, such as registries for evidence 

based practice in the field, will satisfy similar goals for implementation. Training and/or technical assistance often 

is offered to practitioners when implementing effective strategies or programs to ensure that the strategies are 

implemented as they were intended. Though this is considered the final step of the public health model, it doesn’t 

mean that the process is complete. Additional assessments and evaluation are done to assure that all components 

of the strategy fit within the particular community context and have the desired effect of preventing violence. 

Putting it all together

So what does this mean for the decision making process on the ground? How does knowing about the four steps 

help in selecting prevention strategies? One way to look at it is that the Public Health Approach offers a framework 

for asking and answering the right questions. The tool on the next page will help you to do just that. 

Define the 

problem

Identify risk 

and protective 

factors

Develop and 

test prevention 

strategies

Assure 

widespread 

adoption

1. Mercy, J., et. al. (1993). Public Health Policy for Preventing Violence. Health Affairs. 12(4), 7-29.
Using the Public Health Approach

Steps Guiding Questions Potential Resources Example/Exercise

Step One

Define the 

Problem

What (violence-related) problem do I want to prevent? What 

data are available to describe 

the scope and burden of the 

problem?

• How many people are 

affected by the identified 

problem?

• Who is experiencing the 

problem?

• When and where is the 

problem occurring?

National Violent Death Reporting System - 

http://www.cdc.gov/ViolencePrevention/

NVDRS/index.html

Web-based Injury Statistics Query and 

Reporting System (WISQARS) - http://www.

cdc.gov/injury/wisqars/index.html

Kids Count Data Center - http://datacenter.

kidscount.org/?gclid=CMHYqI_7oqMCFcpd

2godz3wZ4Q

ALSO: State and local crime statistics, health 

statistics, child welfare data, etc.

Example: Abusive head trauma (AHT), 

including Shaken Baby Syndrome (SBS) is 

a leading cause of child abuse deaths in 

the United States. According to a study 

of North Carolina AHT cases, as many as 

three to four children a day experience 

severe or fatal head injury from child 

abuse in the United States.

Your turn:

Step Two

Identify Risk 

and Protective 

Factors

Where do I find research to 

answer:

• What are the risk factors for 

the problem? 

• What are the protective 

factors for the problem?

Division of Violence Prevention (NCIPC/CDC) 

- http://www.cdc.gov/ViolencePrevention/

index.html

Example: Caregiver frustration or anger 

resulting from inconsolable crying and 

limited social supports are primary risk 

factors for shaking a baby.

Your turn:

Step Three

Develop and 

Test Prevention 

Strategies

Where do I find information to 

answer:

• Are there existing, effective 

strategies based on best 

available evidence?

• If none exist, what resources 

do I need to develop a new 

strategy based on what was 

learned in steps one and 

two?

• Where can I find research 

partners to help evaluate 

the selected strategy?

• Is the strategy effective – did 

it do what was intended?

The Community Guide to Prevention Services - http://www.thecommunityguide.org/

about/methods.html

Blueprints for Violence Prevention - 

http://www.colorado.edu/cspv/blueprints/

California Evidence-Base Clearinghouse 

http://www.cachildwelfareclearinghouse.

org/scientific-rating/scale

Substance Abuse and Mental Health Services Administration (SAMHSA) National 

Registry of Evidence - http://www.nrepp.

samhsa.gov/about-evidence.asp

Example: A promising or model home 

visitation program. http://ibs.colorado.

edu/cspv/blueprintsquery

Your turn:

Step Four

Assure Widespread

Adoption 

(Dissemination 

and Implementation)

• Who would benefit from this 

strategy (parents, educators, 

policy makers, etc.)?

• How do I get this strategy to 

the people who need it?

• Where can I find 

assistance and support for 

implementing an effective 

strategy and on-going 

monitoring and evaluation 

of the strategy?

National Implementation Research Network 

- http://www.fpg.unc.edu/~nirn/

FRIENDS National Resource Center - 

http://www.friendsnrc.org/

University of Kansas Community Toolbox - 

http://ctb.ku.edu/en/default.aspx

Example: Implementation of a home visitation program that includes a focus on 

specific parental behaviors and modifiable environmental conditions associated with adverse outcomes for children.

Your turn:

Use the tool below to think through a violence-related problem you would like to impact in your community or 

organization. The issue of Shaken Baby Syndrome, one form of abusive head trauma, is used as an example to 

demonstrate the tool. Fill in the shaded areas on the table with examples from your community or organization.