Why Systems Changes that Address Risk and Protective Factors?

Upstream Prevention to Address the Social Determinants of Health and Shared Risk and Protective Factors

Negative health outcomes such as violence, suicide or self-harm, and substance misuse can be stopped before they ever start. Upstream prevention involves identifying and addressing the root causes and conditions that may be contributing to negative health outcomes such as these. To prevent these negative outcomes before they ever occur, we look upstream to examine what underlying conditions may be addressed so the problem never arises in the first place. Watch this 5-minute video to learn more about upstream prevention.

These underlying issues or conditions are often referred to as the social determinants of health or shared risk and protective factors. Risk factors increase the likelihood of a negative outcome, while protective factors buffer against the likelihood of experiencing a negative outcome. These concepts are based on research that has demonstrated that conditions and issues in the environment in which people live, learn, work, and play can affect quality of life and a wide range of health and social outcomes. By addressing these root causes and conditions of multiple negative health outcomes, we take a shared risk and protective factor approach to prevention.

While research has identified many risk factors and protective factors across health outcomes, in Colorado our primary focus has been on risk and protective factors specifically used in the Communities That Care model. Learn more about the risk and protective factors Colorado communities are addressing through systems change strategies.

Given that many of the shared risk and protective factors that contribute to health outcomes are based in the community or environment of individuals, effective efforts must work towards changing systems within community environments to promote positive health outcomes.

Systems Change to Impact Population Health

The largest determinant of an individual’s health status is the community and environment in which they are raised and interact with others. This includes a person’s physical surroundings as well as the social and economic forces and structures that influence their decision-making and behaviors.

Changes in the community and environment can thus change the context in which individuals make decisions and thus tend to be more effective and have higher impact because they reach broader segments of society. Learn more about the Health Impact Pyramid that describes the impact of different types of public health interventions and provides a framework to improve health.

Because these interventions are subsequently focused on changing the community or environment broadly, we refer to these as systems changes, which include the creation or improvement of public policies, regulations, and community systems or structures. Learn more about the core components of systems change, the policy process, and focusing on deep equity to address health disparities.

Systems changes can also be implemented within and across different contexts that address the individual, relationship, community, and societal factors that contribute to individuals’ decisions and behaviors. Learn more about the socio-ecological model and the importance of working across multiple levels in order to achieve population health impact.

While systems change can take time, the shifts in the community and environment where youth grow and thrive are also long-lasting and can have multi-generational impacts. However, it is important to celebrate and emphasize the small victories along the way. Community members can ground one another in these complex and comprehensive efforts by focusing on the principles of emergent strategies.