A Challenge to Unleash the Power of Prevention

By J. David Hawkins, Jeffrey M. Jenson, Richard Catalano, Mark W. Fraser, Gilbert J. Botvin, Valerie Shapiro, C. Hendricks Brown, William Beardslee, David Brent, Laurel K. Leslie, Mary Jane Rotheram-Borus, Pat Shea, Andy Shih, Elizabeth Anthony, Kevin P. Haggerty, Kimberly Bender, Deborah Gorman-Smith, Erin Casey, and Susan Stone*
June 22, 2015 | Commentary


Prevention is the best investment we can make in behavioral health—and the time to make it is now.

Every day, across America, behavioral health problems in childhood and adolescence take a heavy toll on millions of lives. These problems cause deep, often long-term damage to young people, families, schools, and communities. They erode the social contract that one generation makes with another to equip its young people for a bright future.

Behavioral health problems range widely—from anxiety and depression to alcohol, tobacco, and drug abuse; delinquent and violent behavior; dropping out of school; and risky sexual activity and unwanted pregnancies. Behavioral health is defined so broadly because many of these problems share risk factors—and solutions. Preventing one problem often reduces another, or several others.

For decades, the approach to behavioral health problems was to treat them one at a time and only after they were identified—at a high and ongoing price. The cost of treatment services and lost productivity attributed to depression, conduct disorder, and substance abuse alone are estimated at $247 billion per year. Other losses—in lifetimes of compromised potential, the fraying of our social fabric, and the diminishment of our nation’s future—are incalculable.

Now we have more than 30 years of research and more than 50 widely proven programs across the country showing that behavioral health problems can be prevented. This critical mass of prevention science converges with rising awareness and interest in prevention across health care, education, child welfare, juvenile justice, and mental health. Prevention is attaining increased emphasis in transdisciplinary fields of practice, such as primary care. Most notably, the Affordable Care Act’s focus on prevention and early intervention could save as much as $1 trillion every year.

Our nation stands on the threshold of a new age in which costly behavioral health problems are prevented before they do harm. Together, health and human service professionals can take bold steps in creating partnerships that put effective policies and programs into action locally and nationwide. Public health and social work with ecological perspectives emphasizing the interconnectivity of individuals, families, organizations, communities, and policies could be catalysts to unleash the power of prevention.

We propose a grand challenge that will build on current scientific evidence to advance policy, programs, practice, funding, and workforce preparation to promote behavioral health and prevent behavioral health problems among all young people, especially among those at the greatest disadvantage or risk from birth through age 24. We provide a clear, comprehensive plan to decrease the incidence and prevalence of behavioral health problems in this population by 20 percent within a decade. The plan will also significantly reduce racial and socioeconomic disparities in behavioral health problems, enhancing behavioral health equity.

Our grand challenge provides seven actionable goals to achieve this targeted reduction in behavioral health problems. They include detailed outcomes for building awareness, access, investment, effectiveness standards, assessment tools, infrastructure, and workforce capacity. These goals are achievable in the next 10 years, and the outcomes will be meaningful and measurable.

We can promote social justice and public health by transforming extraordinary findings from prevention science into innovative policies and effective programs that will serve millions and save billions. Prevention is the best investment we can make, and the time to make it is now.




Suggested Citation

Hawkins, J. D., J. M. Jenson, R. Catalano, M. W. Fraser, G. J. Botvin, V. Shapiro, C. H. Brown, W. Beardslee, D. Brent, L. K. Leslie, M. J. Rotheram-Borus, P. Shea, A. Shih, E. Anthony, K. P. Haggerty, K. Bender, D. Gorman-Smith, E. Casey, and S. Stone. 2015. A Challenge to Unleash the Power of Prevention. NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201506b


The views expressed in this commentary are those of the authors and are not necessarily of the authors’ organizations or of the Institute of Medicine. The commentary is intended to help inform and stimulate discussion. It has not been subjected to the review procedures of the Institute of Medicine and is not a report of the Institute of Medicine or of the National Research Council.

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