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Starting early – a focus on primary prevention

Family enjoy time outdoors

The LDAT program is centred on primary prevention. It supports community action that strengthens the protective factors (and simultaneously reduces the risk factors) associated with the ‘social determinants of health’.

While the ADF’s purpose is to prevent harms caused by alcohol and other drugs (AOD), the LDAT program enables our work to be focused increasingly ‘upstream’, with the capacity to prevent the uptake of hazardous drug use in the first place.

We believe that establishing links within communities to improve people’s understanding of the social, economic, cultural and environmental factors that drive AOD problems, and then helping these individuals, groups and organisations to better engage and deliver community-specific, evidence-based programs, is the most effective long-term strategy for building stronger, more resilient communities around Australia.

We often find it useful to describe the LDAT program’s approach using a river analogy.

The river

Imagine you’re standing on a river bank and you see a person drowning as they‘re swept along by the current. You jump in, pull them ashore and revive them. A moment later, another person is swept past – they too are struggling to stay afloat. Again you jump in and save them. Soon after, you spot another, then another. You’re aware that soon you’ll be so exhausted that you won’t be able to save anyone else. So you decide to move upstream to see why so many people are finding themselves close to drowning. As you walk upstream, you discover people crossing a precarious bridge – many people are falling from the bridge as they attempt to cross. The answer is clear: if we can build a safer bridge, people will stop falling into the water.¹

In this analogy, the bridge is the combination of the many protective factors that enable a community to function in a healthy manner. These protective factors include healthy relationships, constructive recreational activities, quality education, and programs that provide various forms of social support.

The stronger these protective factors, then the fewer people that will ‘fall’ from the bridge.

Why (and what type of) primary prevention?

As primary prevention focuses on ‘upstream’ protective factors, it can appear as if it isn’t directly tackling the harms caused by AOD. But primary prevention does work.

Well planned prevention programs have made enormous contributions to improving the quality and duration of people’s lives.2

Many of the harms that result from AOD use are health impacts. And the evidence is that simply targeting high-risk groups is not sufficient to reduce drug related health problems.

While selectively targeting these groups can appear to be the most direct approach — and indeed extra support for individuals experiencing the greatest disadvantage is important — those components need to be implemented within a broader ‘upstream’ approach when developing your LDAT’s project.

Understanding the social determinants of health

The ‘social determinants of health’ (SDH) is a term that recognises that a person’s health is not just determined by the decisions they make, but is also influenced by the social, cultural and broader environmental context in which they live.

According to the World Health Organization, the SDH are mostly responsible for the health inequities and the unfair and avoidable differences in health status³ that we see. This means we need to consider and address both the ‘risk’ and ‘protective’ factors that people are exposed to. And ensure that addressing these factors are at the core of our work to improve health outcomes in our communities.

Which setting for your LDAT project?

Understanding where your LDAT’s program fits into the broader strategy for your community is a critical component of your final LDAT action plan. Where possible and appropriate, you will want to link in with broader pre-existing community action plans developed for your locality. Doing this work will be important to your project’s success.

As part of the process to define your setting, you will also need to undertake a range of community consultation. Read more on creating change through community consultation.

Important principles on which to build your project

Understanding what has previously worked, and what hasn’t, is an important starting point for organisations wishing to establish an LDAT. Making yourself aware of this existing evidence base is very important, and should inform your project’s aims and methods.

Link through here to read more about some of the key principles that should inform your LDAT’s work: read about community awareness raising, school and parental education, working in Indigenous communities, or working to deliver behaviour change in your community.

Having said this, the LDAT program is as much about establishing new projects and ways of reducing AoD harm and strengthening communities as it is about building on established practices. For this reason, prospective LDATs are encouraged to build on these key principles with new directions developed by your team.

Examples of primary prevention

We’re gathering examples from Australia and abroad of current primary prevention work to inform and inspire our drug actions teams.

You may like to directly adapt some of these programs for your part of the world, and others might spark new ways of thinking and different approaches for your community to try out.

References

1. Coote, A. The wisdom of prevention. New Economics Foundation, London UK, 2012.

2. National Preventative Health Taskforce, Australia: the healthiest country by 2020: the roadmap for action. Canberra: Australian Government. 2009.

3. World Health Organization. Healthier, Fairer, Safer. The Global Health Journey 2007-2017. WHO 2007.