Q&A with Larry Cohen

Larry Cohen is the author of the new book Prevention Diaries: The Practice and Pursuit of Health for All. His other work includes the book Prevention is Primary. He is the founder and executive director of the nonprofit Prevention Institute, and he is based in Oakland, California.

Q: How did you come up with the idea for Prevention Diaries?

A: I came up with the idea for the book for the same reason that I became involved with prevention overall. I realized many people were getting sick or injured, and there were solutions that would reduce the likelihood and frequency of injuries and illness overall.

I felt a strong conviction that I needed to communicate not just to colleagues about how to do it, but that people everywhere needed to understand there are simple strategies we can engage in that can save lives, reduce misery, and save money at the same time.

Q: The book includes your own personal experiences as well as discussions of various key issues. How did you decide on the book's structure, and did you write it more or less in the order in which it appears?

A: I wanted a structure where the stories would build on one another, and it seemed like for many readers, clustering the book by topic would be most engaging. I added the interludes because I wanted to make the point that our health deeply matters and is a deeply personal issue, and our conclusions about how to achieve well-being are shaped by our personal experiences.

As for the experience of writing it, I kept going back and forth between different chapters as my reflection while doing one would change my perspective on another.

Q: You write, "People often ask how we can measure the impact of prevention if we can't see it. I respond that we can measure prevention over time in terms of lives saved and money saved." Can you say more about that?

A: An example from my own work would be smoking reduction. When I started this work, significantly more people smoked than do now across the U.S. In California, for example, the percentage of smokers has dropped by more than half in a couple of decades— clearly that’s a measure of prevention and the most dramatic reductions align with norms change and regulations.

Another example: we’ve seen young children’s death rates fall dramatically as we’ve watched car seat laws being implemented and other safety measures developed to protect children.  In every case where we have developed major consistent prevention strategies, we clearly see major declines across the population, and these declines fairly consistently follow the implementation of the prevention strategies.

Q: What do you see looking ahead when it comes to prevention initiatives?

A: Some of the initial rhetoric following this election has been about reducing regulations, and I worry that many regulations that protect health and safety may get swept up in this, when in fact they serve to protect us all.

On the positive side, we’ve seen tremendous success in prevention and a recognition by the healthcare sector that community-wide change is key to reducing the pressure of illness and injury on their system—so I think there is still going to be an important outcry for prevention strategies.

And we now know, having learned from our successes, where to go and what to do next. Decisions about whether it’s financially beneficial to help maintain people’s health will be key. Given the national political change, probably the venue of a lot of our work over the next period of time will be more local and statewide.

Q: What are you working on now?

A: Trying to further advance and spread the word about the work of Prevention Institute in promoting prevention and well-being. Two of our initiatives in particular are 1) looking at the link between emotional health and well-being and physical health, and 2) focusing on what we call community-centered health—that is, how to get the healthcare system better aligned with community strategies that promote health.

Q: Anything else we should know?

A: There are several parts of the book where I walk the beach with my dog, which I find incredibly invigorating. It’s a personal reminder that our environment—personal, physical, social, and emotional— is central to our well-being. I think for all of us, a healthy environment is critical and can be restorative. 

--Interview with Deborah Kalb