Primary prevention basics

Prevention pyramid

We all dream of a world where there’s less harm to our fellow human beings, but it may feel daunting to figure out exactly how to do that. Especially this time of year, it can feel like we’re grasping for an ideal purely on faith without data to support how we get there. On the topic of child sexual abuse and other social harms, I have good news: there is data and method to support how we get there. Comprehensively, it’s called primary prevention.

Primary prevention is a topic that many people aren’t familiar with, but experience every day. The universal example of primary prevention is washing your hands before eating so you don’t ingest germs, bacteria, and viruses that may be on them and don’t get sick. Vaccines are another great example. The idea of primary prevention is simply to avoid an undesirable outcome in the first place, whether it’s a disease or something else.  When it comes to social harms like child sexual abuse, though, many are at a loss to understand how exactly we can prevent because most of our systems are designed to instead react when they happen.

Prevention of social harms is a three-prong approach. All three prongs are needed, but in order to be the most effective, they need to be proportional to the evidence we have at the policy level. While that particular aspect is more for researchers, nonprofits, and politicians, it is politicians who overwhelmingly have a say in how money is budgeted at the local, area, and national level. Convincing politicians means convincing the general public.

Primary prevention

The first prong is primary prevention, ensuring people have the resources and support they need so that they make good decisions and not harmful decisions. This includes things like:

  1. Bystander intervention: This is a method of training people to be aware of language and behavior that may not be outright sexual assault or harassment, but enables behavior that can easily lead to sexual assault and harassment. From that awareness, people can then learn how to intervene in those situations. It’s easier than it sounds and can be as simple as reading a short book or watching a training video.
  2. Comprehensive sex, sexuality, and consent education: By this, I don’t just mean the mechanics and physical aspects of sex. This is training people in an age-appropriate way in how to set appropriate boundaries and recognize harmful behavior patterns – the social aspects of sex and sexuality, not so that teenagers can just go out and have whatever kind of sex they want, but so that they can be safer as they inevitably get into relationships that may turn sexual, so they are equipped in how to say no if they need to and recognize troubling behaviors.
  3. Resources: Making sure that people are equipped with the basic things they need to have stable, healthy lives both physically and mentally. This includes career preparedness, tools to overcome poverty, mental healthcare, peer support, and much more. You could classify some political initiatives like single-payer healthcare and universal basic income in this, as they provide some basic resources that all humans need.

Secondary prevention

The second prong is secondary prevention, basically the application of everything in primary prevention, but targeted towards at-risk groups: Demographics that share risk factors that may lead to social harms. We’re talking about low socioeconomic status (see page 25 of this report), minor-attracted people (overall responsible for about a third of abuse), and juveniles (overall responsible for about 40% of abuse) mainly because these groups all have risk factors and ways to mitigate that risk. Secondary prevention is just as important as primary prevention and deserves equal attention with it, not because at-risk groups are ‘potential child abusers’ but because they deserve the support that they need to overcome those risk factors.

Tertiary prevention

The final prong is tertiary prevention, or the prevention of further harm once harm has already happened. This includes things like lowering recidivism in people who have committed a socially harmful crime like child sexual abuse, separating an abusive person from the victim/survivor, and adequate, trauma-informed care for victims/survivors.

Effectiveness and reasoning

Going strictly by the evidence, it is most effective to put our resources more towards primary and secondary prevention because by comparison to tertiary prevention, it is far easier and more practical. Over time, primary and secondary prevention reduces the need for tertiary prevention. That doesn’t mean we shouldn’t separate abusive people from the victims/survivors or provide trauma-informed care or aim to lower recidivism in offenders, it means that we should spend less money by comparison than we do on secondary and primary prevention.

The premise of preventing social harms – and there is a lot of social science research to back this up – is that people do best when they have what they need to survive and thrive. The easiest illustration of this I can give is caring for a pet, since that’s something most people are familiar with. If you provide your pet the appropriate diet, exercise, and care, they will generally live longer, healthier lives, especially when veterinary care is there to guide that. Humans are much the same: We live longer, healthier lives when we have what we need to thrive.

When we don’t have what we need and there are stressors that hinder our ability to thrive, whether that’s job stress, relationship difficulties, poverty, lack of healthcare, trauma, lack of food, shelter, or water… humans do not thrive and can often take up harmful behaviors that range very broadly from substance abuse to harming other humans. Preventing these harms means either giving people the tools they need to cope with these stressors or remove the stressors entirely.

Primary prevention isn’t just about knowing how and why abuse happens, though that’s important to form educational programming and resources for at-risk groups. It’s about recognizing the humanity in other humans and giving them a helping hand when they need it rather than tearing each other down or sowing division and hatred. Compared to the reactive and sometimes violent and barbaric suggestions that people make, it’s obviously the better option.

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