“True compassion is more than flinging a coin to a beggar; it is not haphazard and superficial. It comes to see that an edifice that produces beggars needs restructuring.”

I think this quote truly captures the essence of public health – public health isn’t about treating individuals with band-aids or quick fixes; it is about protecting health and saving lives– hundreds, thousands, sometimes millions at a time – by restructuring the systems that produce sickness, violence, and other problems that ail our society.

“Rarely do we find men who willingly engage in hard, solid thinking. There is an almost universal quest for easy answers and half-baked solutions. Nothing pains some people more than having to think.”

Indeed, we often see programs and initiatives implemented without nearly enough strategic planning and thought to sustainability, input from communities, constructive criticism, and/or evaluation (formative or post-program evaluation). Public health work (any work, really) is difficult and nuanced. We have to think hard and critically about what works and what doesn’t, and whether we are helping, hurting, or making no difference at all. At the risk of repeating myself one too many times – good intentions are not enough.

“All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence.”  

Speaking of good intentions not being enough – I think we all owe it to ourselves and society to not rest upon the fact that we are at least trying to help, but to undertake our work with “painstaking excellence”.  If we’re going to try to do this, let’s try to do it right.

“It may be true that the law cannot make a man love me, but it can stop him from lynching me, and I think that’s pretty important.”

I have to admit, this quote made me laugh. And it’s a good point – laws and policies have their limitations, but they are also an incredibly powerful tool for change, particularly at the level of populations and systems.  I recently came across the Network for Public Health Law, and particularly love their overview of different public health topics.

And lastly, a quote from Dr. King that speaks for itself:

“Our lives begin to end the day we become silent about things that matter.”

One of the most infuriating aspects of the tobacco saga is the role of the tobacco industry and its unlawful and deceptive practices, for which companies have been repeatedly called out and in the U.S. government’s landmark lawsuit,successfully sued. As U.S. District Judge Gladys Kessler stated in the final opinion of this lawsuit: “Despite [the] knowledge [of the harmful effects of tobacco], [the Defendants] have consistently, repeatedly, and with enormous skill and sophistication, denied these facts to the public, to the Government, and to the public health community… In short, Defendants have marketed and sold their lethal products with zeal, with deception, with a single-minded focus on their financial success, and without regard for the human tragedy or social costs that success exacted.”

The stories of deception continue to this day, with a new analysis from UCSF, published just a couple weeks ago in PLoS Medicine, showing that tobacco scientists altered their study protocols to obscure the increased toxicity of additives in cigarettes.

Despite the seemingly never ceasing stories of deception and defrauding the public, U.S. tobacco companies had the audacity to sue the federal government this past summer over proposed graphic cigarette warning labels, saying the warnings violate their free speech rights and will cost millions of dollars to print (the latter point elicits a very bitter laugh, given we’re talking about an industry that rakes in billions and billions in profit).

The case was decided in favor of the tobacco companies in district court, but is currently being appealed (and I was happy to see that 24 attorney generals filed a friend of the court brief a couple weeks ago, saying the First Amendment doesn’t prevent the government from requiring “lethal and addictive products carry warning labels that effectively inform consumers of the risks those products entail”).

But what I’d like to turn to is public reaction to the graphic labels fight. Certainly, there are those that support the use of graphic labels on cigarette packages as a way to discourage tobacco use (there is in fact quite a bit of scientific evidence supporting this). But there are also those clamoring about the “nanny state”.

Public health professionals are pretty used to such “nanny” claims, and I think Yale University’s Dr. David Katz captured it perfectly in his Huffington Post article, ”Public Health and the Illusion of Your Autonomy”, a few days ago:

“You may think you are defending your autonomy by opposing a ban on toys in Happy Meals. But while you are resisting the tyranny of public health, you are playing right into the hands of a large and rich corporatio­n that is far more concerned with its profits than the health of your child.”

EXACTLY. Why are some people so much more willing to be dictated by for profit corporatio­ns (whether in the fast food industry, tobacco industry, or otherwise)  than the recommenda­tions of public health and medical professionals?

They are infuriated by the idea of government placing graphic warning labels on cigarette packets, but seemingly unfazed by the continued deceptive practices of tobacco companies  (including supposed public service announcements about the harmful effects of cigarettes, which have been shown to be ineffective and sometimes even cause youth to start smoking or have more favorable beliefs about tobacco companies – which is exactly what they have worked to achieve).

They are infuriated by the idea of curtailing the freedom of McDonald’s to put toys to Happy Meals, never mind that it was most likely a decision made after “highly-paid marketing executives told them how to manipulate you by manipulating your children,” as David Katz puts it.

What can we do on this front? My advice today is not so much specific action steps, but more about thinking critically. First, let’s look into the “illusion of our autonomy” in a variety of different arenas – who really controls our behaviors and choices, and what are their motives? Then let’s ask, what can we do – on the ground in our communities and in the policy sphere – to limit the sometimes manipulating and deceptive influence of those with their bottom line in mind instead of what’s best for our health and well being? If you have any thoughts about these questions or related topics, please sound off in the comments!

(This post is cross-posted at http://occupyhealthcare.net)

Our #occupyhealthcare principles, and an array of other important causes, are being actively pursued by nonprofits around the world, and many of us have and will in the future donate our money and volunteer our time with these organizations.

In doing so, it is important to remember that good intentions are not enough – a trap we often fall into in social service fields. We think we are helping others, so we go home feeling good about ourselves, but we don’t spend nearly enough time challenging our assumptions about whether or not what we’re doing (or what organizations we support are doing) is actually making any kind of sustainable difference.

The Boston University Economics Club highlights one common trap we fall into in an article entitled “When is it a bad idea to give the poor free stuff?”. This criticism of TOMS Shoes also describes the problem of free stuff outcompeting local goods, but goes further, pointing out issues such as doing things for instead of with people, marketing ploys disguised as awareness raising,  harboring a “whites in shining armor” mentality, and failing to match the needs of those on the ground.

This last one is a particular pet peeve of mine – we often fall into the trap of taking up the cause du jour, never mind what people on the ground actually need. Daniel Halperin addresses the issue of well-intentioned but far-from-optimal (as far as improving health outcomes) donations towards HIV/AIDs prevention and treatment in a wonderful 2008 op-ed in the New York Times. He speaks of the 100-to-1 “disastrously inequitable” imbalance between U.S. spending on AIDS programs ($3 billion) vs. safe-water projects ($30 million) in Africa. This despite the fact that most African nations have a stable adult H.I.V. rate of 3% or less and despite the fact that in certain African countries, AIDS money remains unspent as even state-of-the-art H.I.V. clinics cannot accept such large influxes of cash, and in others, children suffering from basic diseases are left untreated (as clinics cannot afford to stock basic medicines) while H.I.V.-infected children are offered exemplary treatment.

Another example is breast cancer related “awareness-raising” and fundraising in the United States. Injury, violence, and a host of other diseases all claim more lives than breast cancer.  This is not to say breast cancer doesn’t deserve any attention, but all the hype seems to have contributed to misperceptions about the risk of breast cancer vs. other cancers and diseases, not to mention the ridiculous slogans that objectify women, potentially furthering social norms that contribute to gender-based violence and other problems. On top of this, many of the efforts are entirely nonsensical (e.g., Yoplait’s pink yogurt lids) – unless your goal is to increase revenue for the companies that sponsor them. Even more distressing is when the products being promoted in the name of breast cancer awareness actually contain ingredients that have been linked to increased risk of breast cancer.

As one blogger put it, “The ostensible focus of all this pseudo-philanthropic pink jockeying is a kind of nebulous breast cancer “awareness,” rather than any serious effort at prevention or investigation into what actually causes breast cancer in the first place.” One of the comments on this blog post captures the issue well: “If there was some real research into the root causes of cancer or providing widespread access to quality healthcare (prevention, early detection, dealing with the disease, cure) for women, maybe I would understand. Instead a friend gives me a T-Shirt that says “Save the ta-tas” and I am supposed to believe that all is right in the world.”

How can we avoid some of the traps mentioned above, and give in ways that are more likely to contribute to actual, sustainable change?

*Choose wisely – be critical, and do your research. It’s hard to truly measure a nonprofit’s impact, but we can at least try to get a better sense of their work. What exactly does the organization do? How well does what they do match the needs of those they aim to help? What does research and evaluation say about the kinds of tactics they use? Is their work sustainable? Are they engaging and empowering those they try to help?  In addition to these, goodintents.org provides a fabulous list of  Dos and Don’ts for Disaster Donations and issues and tips related to voluntourism, and Think Before You Pink provides questions to ask before you buy pink (but much of what they say is relevant to looking into any cause).

*When volunteering, maximize your impact by volunteering in a way that puts your skills to use. Check out sparked.com: even more than their online, micro-volunteering approach, I appreciate the idea of trying to match a person’s skills (web design, marketing, legal, etc.) with the needs of an organization.

*Start local. Contributing your time and money to local organizations doing good, smart work (choosing wisely is still important) can help build a sense of community (for you and those you work with) and help you build long-term relationships with the organizations you choose to support and those that turn to the organization for its services. It can also be easier to get a sense of an organization’s work when you can be there in person – it’ll make for wiser giving anda more personal sense of the impact the organization and your support is having.

Here’s wishing everyone Happy and Wise Giving in 2012!

(This post is cross-posted at http://occupyhealthcare.net). 

As the Prevention Institute points out:

*The food and beverage industry spends approximately $2 billion per year marketing to children.

*The fast food industry spends more than $5 million every day marketing unhealthy foods to children. 

*Kids watch an average of over ten food-related ads every day (nearly 4,000/year).

*Nearly all (98 percent) of food advertisements viewed by children are for products that are high in fat, sugar or sodium. Most (79 percent) are low in fiber.

In a study comparing the nutritional content of food items observed during advertisements (during 84 hours of primetime and 12 hours of Saturday-morning TV broadcast during the fall of 2004) to the recommended daily values, researchers found that a diet consisting of observed food items would provide 2,560% of the recommended daily servings for sugars, 2,080% of the recommended daily servings for fat, 40% of the recommended daily servings for vegetables, 32% of the recommended daily servings for dairy, and 27% of the recommended daily servings for fruits.

This disproportional marketing of foods high in fat and sugar might be concerning in and of itself – but the real problem is that it’s working. Beyond the evident fact that childhood obesity is an enormous problem in the United States, numerousresearchers and government agencies have found specifically that marketing and advertising of foods does in fact impact children’s food preferences, as well as purchase requests directed to parents and short- and long-term dietary consumption.

Moreover, in recent years, researchers at the Yale University Rudd Center for Food Policy and Obesity have concluded that “the traditional models used to explain advertising effects have overemphasized the importance of children’s understanding of persuasive intent”, echoing an Institute of Medicine Report which points out that although the most common models used to explain the effects of food marketing assume a conscious and rational path from exposure to behavior via persuasion, more recent psychological models suggest repeated exposure to food advertising can lead directly to beliefs and behaviors without active, deliberate processing of the information presented.

In this context, branding and cues such as cartoon spokescharacters, colorful packaging, and pictures have been identified as important in this link between food advertising and beliefs and behaviors. Studies have shown that children 3-5 years prefer the taste of baby carrots, milk, and other products out of a McDonald’s bag and that kids 4-6 years prefer the taste of graham crackers and gummy fruit snacks with Dora, Shrek or Scooby Doo on packaging.

If that’s not worrisome enough, the Prevention Institute has more statistics for us:

*Nearly 40% of children’s diets come from added sugars and unhealthy fats.

*Each day, African-American children see twice as many caloriesadvertised in fast-food commercials as White children.

*Even five years after children have been exposed to promotions of unhealthy foods, researchers found that they purchased fewer fruits, vegetables and whole grains, but increased their consumption of fast foods, fried foods and sugar-sweetened beverages.

*By 2030, healthcare costs attributable to poor diet and inactivity could range from $860 billion to $956 billion, which would account for 15.8 to 17.6 percent of total healthcare costs, or one in every six dollars spent on healthcare.

So what can we do? I think the solution lies in not only in trying to limit the marketing of unhealthy foods to children but also in tapping into their strategies (which clearly work) to promote healthy options to kids. As the Institute of Medicine points out, the field has “underutilized the potential to devote creativity and resources in promoting food, beverages, and meals that support healthful diets for children”. One of the few examples I’ve come across: the recent baby carrots campaign, which “takes a page out of junk foods’ playbook and applies it to baby carrots” with Doritos-like packaging, seasonal tie-ins like “scarrots” during Halloween, and TV spots that portray baby carrots as extreme and futuristic.

We have a responsibility to be creative and tap into strategies that work when it comes to marketing healthy foods – not just preach and list facts (since we all know how appealing kids find that technique).

We also have a responsibility to step up and speak up against the massive junk food and fast food industries in their aggressive marketing to children – the Prevention Institute has a great video and easy action items on this front.

Check it out and add your voice to the discussion!

(This post is cross-posted at http://occupyhealthcare.net)

As this video from the Center on the Developing Child illustrates, in looking at determinants of health and well being, it is important to consider the enormous influence early childhood and later youth development have on children’s futures. Physical, social, and emotional health and well being, as well as factors related to health and well being such as education and income levels, can often be predicted from childhood exposures. Moreover, brain development research suggests young people are particularly receptive to prevention and youth development interventions and supports, as well as strategies geared towards developing resilience and social competence.

In a 2010 report entitled The Foundations of Lifelong Health Are Built in Early Childhood, the following framework is put forward.

The framework highlights much of what we are striving for here at #occupyhealthcare – public health, community development, primary healthcare – all with the goal of better health across the lifespan.

And while interventions and supports in very early childhood are critical, continuing this support through adolescence is also imperative. Young people who are surrounded by a variety of opportunities for engagement encounter less risk and ultimately show evidence of higher rates of successful transitions into adulthood.

The positive youth development movement centers around cultivating five essential characteristcs, commonly known as the five Cs:

While both early childhood development and positive youth development are extensive fields, with a vast array of research and related programs and policies, this simple introduction establishes the essence of these fields and the link between them and health and well being.

So, what can we do? This week’s action items:

*Support evidence-based positive childhood and youth development programs by volunteering, fundraising and donating, and advocating for policies that help sustain and expand them.

*Be a mentor – January is National Mentoring Month, and what better New Year’s Resolution can we make than to invest in the future by mentoring a child?

(This post is cross-posted at http://occupyhealthcare.net/)

An op-ed in the New York Times last week described the United States’ disproportionate spending on healthcare in comparison to other social services that have an impact on health – a characteristic that puts us in the minority, as one of only three industrialized countries. The chart below shows the ratios of healthcare:social service spending in the U.S. vs. peer countries (for details on these numbers and information on which countries are included, check out the published study).

In addition, when considering the combined spending on health and social services, the U.S. no longer leads the pack (as it does when examining only healthcare spending) – in fact, we come in 10^th of 30 OECD countries examined. Furthermore, the authors of the study found that infant mortality, life expectancy, and potential years of life lost outcomes were significantly worse in countries where health-care spending was high and social-service spending low.

As the authors note, “The implication of our findings is that, if improved population health is our goal, then the United States should be looking beyond the health-care system to achieve that goal. Current reforms—targeting medical care and health services only—are unlikely to deliver that result.”

Amen. So, let’s look beyond the healthcare system. Each Monday starting today, I’m going to kick off our week here at #occupyhealthcare examining something outside the healthcare system that has enormous implications for our health (i.e. social determinants of health). I’ll try to end each post with a practical step or two you can take to address the topic at hand.

This week, let’s talk urban planning.

The idea that where you live, learn, work, and play is a major – perhaps the major – factor influencing your health is a core principle of public health.  Place matters.

While this idea encompasses far more than just physical living space, physical living space is certainly a key component. Development decisions can affect our physical health (through walkability, green spaces, proximity to healthy foods, pollution caused by vehicular traffic), our emotional and mental health (length of commutes, spaces for social interaction) and societal well being (spaces for civic engagement, degree of segregation by race and income).

Many in the fields of urban planning and public health have come to this realization, epitomized by the smart growth movement, which holds among its principles:

*Mixed land uses

*Mixed income housing – providing a range of housing opportunities and  choices

*Taking advantage of compact building design

*Creating walkable neighborhoods

*Preserving open space, farmland, natural beauty, and critical environmental areas

*Fostering distinctive, attractive communities with a strong sense of place

*Providing a variety of transportation choices

*Encouraging community and stakeholder collaboration in development decisions

Imagine the potential benefits:

*Less segregation could lead to more equitable policies across communities, and ultimately more equitable health and wellness outcomes

*More walkability and green spaces could increase physical activity

*Providing a variety of transportation choices could minimize our reliance on motor vehicles, and the resulting pollution and sedentary lifestyle

*Attractive communities with a strong sense of place could make us happier and more connected, reducing rates of depression

The list goes on. Moreover, many of these benefits have already been demonstrated through research. It is clearly time for us – and the U.S. – to invest in smart growth for healthier, happier communities.

So, what can we do? Today’s practical step: encourage use of health impact assessments in your local community when any kind of development project is being discussed, and advocate for state and federal laws that mandate or incentivize HIAs. HIAs provide a way to assess the health impact of any policy (development or otherwise) and would likely reveal the positive impact of smart growth, and the detrimental impact of development projects that don’t take into account smart growth principles. Certainly, there are complexities and challenges involved in conducting HIAs, and it is important to make sure they are being conducted in useful, cost-effective ways – but that is a topic for another post! Despite the complexities, I think HIAs when done well provide a concrete way to start thinking about the specific ways in which any policy that impacts the places we live also impacts our health and well being – and hopefully provide the impetus to start not just thinking about, but acting upon the results.

In my last post, I wrote about the importance of occupying an array of fields that impact our country’s health. Lest this task seem too daunting to be accomplished, I thought I’d take a moment to highlight some success stories on this front.

Access to healthy foods is an important determinant of health and an important factor in health inequities. The Food Trust, a non-profit based out of Pennsylvania, is tackling this problem, aiming to make healthy food available to all. Among their many innovative projects is the Pennsylvania Fresh Food Financing Initiative, a grant and loan program to encourage supermarket development in underserved neighborhoods throughout the state, an idea that is now being replicated nationally. Some other creative developments in the field of nutrition and healthy food access: taking a page out of the junk and fast food industry’s book, with their billions spent on marketing, and branding baby carrots in a way that’s fun and exciting; and tapping into behavioral economics to redesign cafeteria lunch lines in a way that increases purchase of healthy foods and decreases purchase of unhealthy foods (an inexpensive and effective approach!).

Given that homicide and suicide are among the leading causes of death among those age 1 to 34, violence prevention is another key aspect of attaining the health our society deserves. Chicago-based CeaseFire combines research and street outreach to track violence, interrupt and intervene (with well-trained professionals from the communities they represent with a background on the streets), and engage in longer term risk reduction and behavior and norm change. Even more exciting – it’s working.

Neither access to healthy foods nor neighborhood safety – not to mention walkability, pollution-free environments, and a host of other things – is possible without intelligent and innovative urban planning. Thankfully, we have the likes of The Congress for the New Urbanism working to promote walkable, mixed-used neighborhood development, sustainable communities and healthier living conditions.

And while our national political discussion is so bogged down by discussions of whether to help low-income individuals and families that we haven’t had a conversation about how best to help them, organizations like the Family Independence Initiative, which was featured in the New York Times this past summer, are taking an approach radically different from our typical social service model, tapping into the strengths and support systems of low-income families, allowing them to determine their own paths and advance together. This too, has been shown to work.

Across all of these health-related issues, the media plays a role in shaping behaviors and norms, and Hollywood, Health, and Society is bridging two drastically separate sectors with its work to provide entertainment industry professionals with accurate, timely, and engaging information and case examples for health storylines, as well as study the content and impact of these storylines.

Of course, just because it’s not all about healthcare doesn’t mean healthcare isn’t at the table – healthcare providers can play just as important role in prevention and promotion as they do in treatment, and places like the Codman Square Health Center make that crystal clear. A community health center in one of the most impoverished areas of Boston, the Center provides a range of public health and community services (ranging from computer classes and financial help to fitness opportunities and hands-on cooking classes, not to mention youth services, civic engagement initiatives, and a close linkage with the Codman Square Academy charter school).

So, as daunting as the task of occupying for health seems, there are many people in many places doing amazing things. To quote the founder of the Codman Square Health Center: “We need to create integrated systems that promote community and health values. Like all change such cultural shift will take a generation or more to accomplish. But I am reminded of the story President John F. Kennedy told of the French leader who asked his gardener to plant a rare tree on his estate. ‘But the tree won’t bloom for 100 years’ the gardener said. The response: ‘In that case, plant it this afternoon.’”

So here’s to starting planting – and occupying. Cheers.

Certainly, there is a need to occupy healthcare. Healthcare is essential, and the prevention and treatment that happens in clinics and hospitals, emergency rooms and community health centers, is integral to improving and saving lives.

We must occupy the criminal justice system. The U.S., with less than 5% of the world’s population, has almost 25% of its prisoners, the majority of whom arepeople of color, people with mental health issues and drug addiction, and people with low levels of educational attainment. This exacerbates poor health outcomes related to substance abuse and mental health; worsens health inequities by race, ethnicity, and socioeconomic status; and to boot, has done little if anything to make neighborhoods safer.

We must occupy the news and entertainment media. Whether it is news stories that inaccurately and dangerously link bullying directly to suicide in a way that can elevate suicide contagion risk by suggesting suicide is a natural response to bullying; fictional TV characters eating hordes of junk food day in and day out, without any consequences; or music videos that normalize gender-based violence, the media play an enormous role in our perceptions of what is “normal”, shaping our behaviors in a way that has significant impact on health outcomes.

And as the Prevention Institute alerted me to via e-mail, the Senate Appropriations Committee approved a bill on September 21^st that “zeroed out funding for the CDC’s Youth Violence Prevention activities – suddenly and without input”.

The e-mail I received pointed out that elimination of this $19.7 million in funding would have a devastating impact on violence prevention efforts across the country and compromises decades of work.

I agree wholeheartedly. Even more frustrating though, is the fact that not only do these cuts to prevention and public health funding affect critical work, they go against the very purpose of these funding cuts, i.e. “economic growth and deficit reduction.”

Cutting prevention funding does NOT help the economy or the deficit. Whether it’s the Prevention and Public Health Fund, CDC’s Youth Violence Prevention efforts, or other funding streams, public health takes a systems level, upstream approach to preventing population-level health problems – this means a lot of public health efforts are targeted at things like helping people find jobs or gain a better education, and making neighborhoods safer and revitalizing communities. These things make our economic situation better, not worse.

As the Prevention Institute points out:

“Cutting prevention may seem to save a few dollars in the short run, but it will cost an enormous number of lives and money in the long run…Prevention shows a 5-to-1 return on investment. Cutting 3.5 billion in prevention would shut the door to as much as $20 billion in potential savings in health care costs in the future.”

And there are a lot of other cost savings too – keeping youth out of the criminal justice system, keeping community members gainfully employed, and more.

I understand that cuts need to be made, but let’s stay away from cutting things that are actually saving us money, shall we?

Pick up the phone, call your senators and representatives (I just did!), and try to make it to clear to politicians and the general public that prevention funding is not merely an expendable cost, but an investment – and one that is far more likely to pay off than pretty much any other.

And as this NAACP report points out, there’s a lot more to worry about:

-  The majority of the 2.3 million people incarcerated in U.S. prisons and jails are people of color, people with mental health issues and drug addiction, people with low levels of educational attainment, and people with a history of unemployment or underemployment. (According to a 2008 study, 1 in 100 U.S. adults of any age and 1 in 9 black men ages 20-34 are in prison).

-  The nation’s reliance on incarceration to respond to social and behavioral health issues is evidenced by the large numbers of people who are incarcerated for drug offences – nearly a quarter of all those incarcerated.  (And as mentioned here, in 1980, we had 41,000 drug offenders in prison; today we have more than 500,000, an increase of 1200%.)

- During the last two decades, state spending on prisons grew at six times the rate of state spending on higher education.  (And according to a Pew report, total state spending on corrections, the bulk of which is spent on prisons, quadrupled during the past 20 years, making it the second fastest growing area of state budgets, trailing only Medicaid.)

Even worse – much of what we do in terms of incarceration does not seem to be preventing crime, much less helping people escape the various vicious cycles that can lead to things like poverty, crime, substance abuse, poor education, poor health, etc. This can be seen not only in the recidivism rates mentioned above (with about 1 out of 4 American offenders ending up right back in prison within three years of release), but also limited drug offender effects,  negative impacts on family and community, and other issues detailed in this Sentencing Project report. Moreover, as the report goes on to say, “a variety of research demonstrates that investments in drug treatment, interventions with at-risk families, and school completion programs are more cost-effective than expanded incarceration as crime control measures.”

The call is echoed in editorials such as this one, written to describe a consensus reached in a Pennsylvania conference among prosecutors and defenders, victim advocates, prison reformers, and parole officers and judges. The consensus: the need for a change in the justice paradigm, from a system focused primarily on punishment to one emphasizing restorative practices. The editorial goes on to highlight a number of public health strategies as promising alternatives including therapies that address addictive behaviors and mental and emotional disorders.

And there have also been repeated calls to take some of the billions of dollars we spend on incarceration and put it toward education, one of the more recent calls coming from Gaye Tuchman, a University of Connecticut sociology professor, in one of this week’s New York Times Room for Debate articles about Rick Perry’s “plan” for a $10,000 B.A. degree – “New money for education has to come from somewhere,” Tuchman writes. “Why not a new kind of retrenchment: Cut back on imprisonment for some victimless crimes — like marijuana possession — and use the money for higher education. As The New York Times reported in February, arrests for marijuana use have been skyrocketing in New York City alone. Better to educate people than lock them up.”

And indeed better to educate and support high risk youth than lock them up. Let’s target youth in high risk communities (a la “hot spotters”) for intensive tutoring and mentoring support, provision of safe spaces, and more, providing them with role models and people and places to turn to when in distress or in need of help accessing various resources.

John F. Kennedy once said “children are the world’s most valuable resource and its best hope for the future” – let’s invest in this resource and nurture this hope, preventing our children from entering the criminal justice system in the first place.