health impact pyramid preventionThe Health Impact Pyramid (Frieden, 2010) provides a framework to guide health promotion efforts. The pyramid describes 5 levels of intervention to prevent poor health outcomes and promote well-being. The levels are organized according to the individual effort required to participate in the interventions and the interventions' ability to change population-level conditions. According to the model, these two are inversely related (i.e. those interventions that require the most individual effort have the least potential to create widespread change).

Much like the familiar Hierarchy of Needs proposed by Abraham Maslow, the base of the pyramid reflects the most fundamental of interventions to promote health: assuring positive and equitable socioeconomic conditions for all. This represents the foundation on which all health promotion efforts must be built; the prerequisite for well-being. Individual-level counseling and education are situated at the peak of the pyramid, representing a class of interventions that require substantial individual participation and produce minimal impact on population-wide conditions. These are the interventions with which practitioners in the violence prevention field may be most familiar. They include school-based violence prevention programs and therapy for youth with elevated risk for violence. These programs are capable of producing significant changes in individuals' attitudes and behaviors when they are delivered with adequate dose. They are an essential part of violence prevention. They are, however, fairly expensive and time-consuming to carry out. As a result, they tend to reach fewer people. What's more, they do little to change the contexts and environments in which people live, work, play, and learn - all of which have a greater influence on health than individual traits do, and all of which are essential to bolstering the effects of counseling and education.

Throughout Prevent Violence NC you'll find examples of interventions situated at each level of this pyramid. As you begin the process of selecting or developing violence prevention programs appropriate for your community, note which level of the pyramid they address. We encourage you to make an effort to seek out strategies that move your work closer to the base of the pyramid, closer to improving socioeconomic conditions, and closer to ensuring health and equity for everyone in the community. For another take on the Health Impact Pyramid, check out this short and insightful blog post by Jonathan Purtle from the Drexel University School of Public Health.