IcongratulateDavidFoxcroftforthisfinepaper“Canpreven-tionclassification beimprovedby consideringthe functionofprevention?” In essence, it proposes, in addition to the classi-fication into universal, selective, and indicated (“forms”),another axis, where environmental, developmental,and infor-mational approaches are introduced as “functions.” In thissystem,environmentalpreventionwouldnolongerbeafourthcategory complementing universal, selective, and indicatedprevention, but another functional dimension, pervadingtransversally the three forms of prevention. When Davidpresented his model at the Second Annual Meeting of theEuropeanSocietyforPreventionResearch,Iwaspuzzled,andsincethen,havecontinued pondering whetherthisproposalisreallypreferableto themodel wehavebeenpromotingwithinthe EU.AnumberofDavid’s critical comments on the existingmodel present me with problems as follows:1. David makes a point that in the current model, environ-mental prevention would overlap with universal preven-tion, and even with selective and indicated prevention,because it can have differential effects or may addresscertain groups only, such as minors. Taken to its logicalconclusion—the argument that measures lack universali-ty—then only mass media campaigns are universal, be-cause all other approaches commonly labeled“universal”target sub-populations, like young people, working peo-ple,andsoon.Ihadalwaysunderstoodfromtheliteraturethat the defining characteristic of “universal” is that thevulnerability of the target population is not assesseddifferentially.Besides,themodelwehavebeenusinguntilnow was not meant to consist of clear-cut side-by-sidecategories,butratherofspheres-within-spheres,similartoBronfenbrenner’s 1979 model of macro-, meso-, and mi-crospheres of influence. Environmental prevention, here,isanoutersphere,whichtargetsphysical,social,econom-ic, and virtual environments. In contrast to the other threeforms, it does not target people directly (i.e., in directinteraction). Nevertheless, all four approaches obviouslyaim at behavioral change of individuals. Therefore, I donot see it as conceptually confusing that the outer sphere,in the form of family norms and socialization—as exam-ples of environmental prevention—has effects on an in-dividual child.Most of uswould agree that all preventionstrategiesaim atultimatelychangingindividual behavior;the environmental ones by changing context, the otherthree by persuasion according to differing vulnerabilitiesand needs. That environmental strategies can be carriedoutwithincommunitystrategiesdoesalsonotconstituteaviolation of the category system: all four forms (or“spheres”) ofpreventioncan becarriedout inall classicalsettingsforprevention.Lastly,evenifgun-controllawsorage limits might affect only or mostly those most at risk,they are still applied to society and the population as awhole,unlikeindicated approaches, whichtarget selectedindividuals only.2. David seems to interpret environmental prevention asrestricted to regulation alone. However, non-coercive en-vironmentalinfluencesonbehaviorcanalsobeclassedasenvironmental prevention, even if sometimes the borderswith health promotion may be ill-defined. Examples arepositive school or learning climate and the spatial andlogistical arrangement of nightlife events. None of theseimply changing behavior by persuasion.3. I would not subscribe to the view that universal ap-proaches “are generally more impactful on better off,lower risk population groups. ” Rather, it seems—when
Read full abstract
May 6, 2015
Catherine Fitzsimmons + 1
Open Access