Systemic approach for injury and violence prevention: what we can learn from the Harlem Children’s Zone and Promise Neighborhoods

An escalating volume of injury prevention research over the past half century has dramatically increased our understanding of the risk and protective factors associated with injury and violence, and the efficacy of interventions for addressing these risk factors across the social ecology.1 2 However, this increased understanding has not resulted in widespread adoption and implementation of evidence-based and evidence-informed interventions, and countries such as the USA are still experiencing increased rates of injury and violence morbidity and mortality.3 The disassociation between our knowledge of injury causation and effectiveness of our efforts to reduce injury has been discussed in the injury prevention literature as the ‘research to practice gap’ and has focused primarily on the disconnect between evidence-based programmes and their wide-scale adoption.4 This research to practice gap evident in injury prevention is simply a special case of the more generic challenge evident throughout the public health field. Disciplines and approaches such as translation research and implementation science have emerged to help bridge this gap and facilitate the spread of evidence-based prevention programmes.4–7 This has included the development of tools, resources and methods to support and engage communities in the implementation of evidence-based injury and violence prevention programmes.7–10 However, translation research and implementation science have been developed largely within the existing paradigms of laboratory and clinical research.11 Some in the field of public health have begun to question whether the ‘research to practice gap’ is truly limited to the uptake of evidence-based programmes or if it may actually be a much broader disconnect requiring more integrated, multifaceted approaches to knowledge generation and application.3 Similarly, population health research is now recognising that efforts to achieve community-level well-being are more likely to be effective when they focus on systems change, and when they are not limited …