Taking two steps to prevention is a way to trace the pathway from illness and injury to community conditions, norms and root factors that lead to poor health and inequality in the first place. It focuses efforts on a comprehensive, systemic basis rather than a narrow individual one. The traditional health system trajectory in the United States starts with the medical condition, such as a heart attack, and immediately moves to medical interventions and the drugs needed to treat the illness. Taking the first step to prevention identifies risk factors, such as poor diet, sedentary behavior, and stress. Taking the second step out is critical: It reveals the environment that shapes the factors leading to the heart attack—an environment that lacks available opportunities for safe physical activity—and promotes cheap fast food on the run.
Racism, sexism, and economic inequalities have produced environments that are further compromised—ones with ongoing stress and even less support for healthy behaviors. Taking two steps to prevention—focusing on the community environment—is an important element of quality prevention, because tangible solutions lie within the local arena. By applying these solutions, advocates, practitioners and researchers can improve community conditions, increase resiliency, and challenge root factors like poverty, oppression, racism, and discrimination, which undermine health and reinforce inequities.