HealthScaping NorthWest

Creating healthy, vibrant communities

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Changing the Conversation about Gun Violence

The Epidemiologic Triangle: Changing the Conversation about Gun Violence

Public health practitioners use a tool called the “Epidemiologic Triangle” to identify the causes and transmission of an epidemic, and to identify points of intervention:

How do we end gun violence?

The points of the triangle are the Environment, Host, and Agent. How can we use this concept, this vocabulary, to talk about gun violence?

Understanding the Triangle:

Take malaria for example: The Agent is a parasite. Mosquitoes are the Vector–they transmit malaria to the Host. The Host? Humans. And the Environment brings them all together.

Malaria can be addressed by changing the Environment (percolating water, mosquito dunks), cutting down on the Vector by reducing the mosquito population, and by improving the Host’s (human’s) resistance through medication.

To be effective, all must be done.

Applying the Triangle: Smoking-Related Diseases

In tobacco prevention, multiple strategies are used to effect change:

  • Improve the Environment: pass smoke-free workplaces laws
  • Limit the Agent: reduce access to cigarettes (no sales to minors, taxes)  Note:despite the diagram THERE IS NO SAFE CIGARETTE, and FILTERS DON’T WORK!
  • Limit the Vector, otherwise known as Big Tobacco: stop them from marketing to children (remember Joe Camel)
  • Build resistance in the Host: Quit Lines, quit-smoking medications, education, school programs

So how can we apply this to gun violence?

If we are committed to change, we must address all of these factors.Here is my simplistic first pass at it:

Agent: guns.

Semi-automatic assault weapons, are the common factor in these shootings. They are designed to kill people, not for hunting or “sport” or defending yourself against an intruder. They kill many people, quickly.  Many gun owners support getting military-style weapons off the streets.

Vector: shooters, often mentally ill or criminal… or just children who are playing with a household gun.

We need to have a robust mental health system, including support for people with mental illness and other disorders. We need to do everything we can to prevent child abuse and school bullying. We need to make sure the community has plenty of activities to engage our children.

Host: the victims

Short of issuing bullet-proof vests, I’m at a loss here. A school security guard with a hand-gun isn’t going to be able to defend a class full of children from a shooter.

Environment: a culture that makes guns easy to get.

The United States has the highest rate of per-capita gun ownership: 88.8 guns per 100 people. The next two closest countries, Serbia and Yemen, have gun ownership rates around 58 and 54 percent.

We have the 12th highest rate of gun deaths of any nation, around 9 deaths per 100,000 people. Our gun death rates far outstretch any industrialized nation, which have about 1 death per 100,000 or less. People are dying from gunshots at a rate similar to South Africa and Montegro, not European countries or Canada.

So what do we do? What are your ideas?

How do we come together to change ALL parts of this triangle?


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HealthScaping at Work: Healthy Eating

We spend the majority of our waking hours at work.

working hours

How much time do we spend at work?

We are what we eat…We eat where we are

During the workday, we eat at least one meal and, often, a couple of snacks. Americans eat out about five times a week, with half of these meals at lunch. All the health education brochures in the world won’t get people to eat healthier if the only options available are deep-fried, highly-processed, or laden with fat, sugar, and salt. Healthy foods in the cafeteria, vending machines, and nearby restaurants would go a long way to support employees’ efforts to eat healthy.

Programs are even more successful when they include price incentives, such as subsidized salad bars; nutrition labeling; and meatless options. Taste tests and surveys are a great way to introduce new foods and build employee excitement.

Innovative strategies include starting a farmers’ market or farm stand on the premises, or making it easy for employees to pick up boxes of fresh produce by enrolling in a Community Supported Agriculture (CSA) program.

Some workplaces go the extra mile and set policies of:

  • no candy on desks
  • healthy food at meetings and conferences (fresh fruits and veggies, whole grains, fat and sugar limits)
  • no food provided at meetings less than three hours
  • water instead of soda or other sugar-sweetened beverages
  • healthier vending and procurement practices

The Three A’s: Attractive, Available, Affordable

Key to program success is making tasty and healthy foods attractive, available and affordable, while reducing the availability of unhealthy options.

Support employees’ attempts to eat healthy by making sure the food environment is in line with your workplace wellness promotion goals. This is part of what the Wellness Councils of America (WELCOA) describes as Benchmark #6 Creating a Supportive Environment. Such “environmental interventions” go above and beyond health education to make sure that employees have the resources to act: policies, physical incentives, rewards and incentives that support their health decision-making.

According to WELCOA, involving employees in changing the workplace nutrition environment is critical. Include a variety of employees in your Workplace Wellness Committee. Seek input through surveys, focus groups, suggestion boxes, and staff meetings.

It is likely that many employees are trying to lose weight or maintain a healthy weight. A survey will generate data demonstrating how many employees have weight loss goals, and how much support there is for changes in the food environment. A survey will help your Workplace Wellness Committee set goals and select priorities. Such data will also prove to be persuasive in “bringing along” employees and managers who may be less enthusiastic about the changes.

Seeking continuous feedback, making adjustments as you learn what’s working and what could be improved, and posting positive comments from employees in newsletters, on the website, and on bulletin boards will also increase your changes of long-term success.

Healthier Workplaces Help Us All WorkWell 

Worksites are a critical setting for addressing the chronic diseases that plague our community and increase healthcare costs. We can prevent and manage chronic diseases through proven programs and policies that help people quit tobacco, eat healthy, get more physical activity, and manage stress. A comprehensive approach that includes wellness education, healthcare incentives, and supportive workplace policies (such as healthy vending) is necessary for improving employee health, as well as employers’ bottom line.

Future installments will feature strategies to help employees quit tobacco, get more physical activity, and manage chronic diseases, as well as how to guide your workplace through the change process, using the WELCOA benchmarks.