REBUILDING AFTER SEPTEMBER 11: CONSTRUCTIVE ACTIONS TO SUPPORT HEALTH AND A RETURN TO WELL BEING

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Following the September 11 terrorist attacks, Prevention Institute produced a paper entitled Rebuilding after September 11: Constructive Actions to Support Health and a Return to Well Being. The paper presents 13 suggestions for coping with an event of that magnitude, and for promoting individual and community well being in general. While some aspects of this paper resonated more in the immediate aftermath of a national tragedy, many of its recommendations are still relevant for our daily lives. Prevention Institute hopes that the importance of promoting health and wellness is just as evident today as it was following the attacks on New York and Washington, D.C. To that end, we invite you to take another look (or a first look) at this paper, and hope that you will find the suggestions meaningful and helpful as you continue to strive for personal and community well being.

1. Talk About It

It helps to get support from your family, friends, and colleagues. Similarly, you can serve as a valuable support resource for others. Talking about tragedy and trauma and our reactions to them helps us to cope. It aids in processing the magnitude of what's happened and our feelings about it. Check in with those you care about and give them an opportunity to express the range of their emotions and reactions. Some people may need more help than you can provide. They might let you know directly or you might notice drastic changes. If this is the case, you might be able to assist them in finding appropriate professional services.

While many adults are having a hard time processing the terrorist attack and its consequences, it is even more difficult for younger people. These events were so sudden and so extreme that the usual protections we try to ensure for our young people were largely ignored. With an uncertain sense of the world and their own safety, youth may be more likely to participate in risk-taking behavior. Talk with young people, honor their perspective, help them find ways to contribute, and give them a sense of hope. Young children will have an even more difficult time processing an event of such magnitude and making sense of what they see on TV and hear around them. Here's what you can do: 1) reassure children they are safe; 2) answer their questions; 3) be available; 4) acknowledge, validate, and encourage a child's feelings; 5) continue their routines; 6) be alert to behavioral changes. Most importantly, know that their view of the situation will depend on how you react. Schools, childcare, and extracurricular programs can ensure that children and youth have appropriate venues in which to express themselves. School counselors support the mental health needs of students and let teachers know what to expect. Administrators can ensure that teachers have guidance, support, and training to best meet the emotional needs of students at this time.

Workplaces can provide a forum for employees to appropriately express themselves. This can include check-ins at staff meetings, holding special meetings and events, or encouraging employees to support each other. Employee assistance programs can also be a source of support. When given a chance to heal, compromised productivity is likely to return to normal levels. Communities and neighborhoods can create opportunities for residents to share with each other and heal together, including town hall meetings, speak-outs, and vigils.

For more information on talking to kids, please visit http://www.cce.cornell.edu/issues/cceresponds/ or http://www.connectforkids.org/. For a free, 25-page curriculum for middle and high school students, Beyond Blame: A Reaction to the Terrorist Attack, go to https://secure.edc.org/publications/prodview.asp?1479.

2. Acknowledge the Range of Reactions

We are all experiencing a diversity of emotions including sadness, anger, fear, insecurity, and confusion. They vary from moment to moment within each of us and they vary among us. Similarly, people are expressing a range of desired outcomes following the terrorist attacks that range from retribution to a commitment to peace. The reasons for these outcomes are just as varied -- revenge, justice, regaining a sense of safety, a philosophy that any more violence is wrong or that it will only escalate an already unacceptably high level of violence. This vicissitude of emotion and reaction is to be expected and respected.

The first step in the healing process is to acknowledge your own range of reactions and know that this is normal. Next, know that others are also experiencing a variety of emotions and thoughts. While they may not be the same as yours, they are also valid and real. Talking to others and understanding their perspective, even if they seem diametrically opposed to yours, can help build connections among us. Make sure that this dialogue is as respectful as possible -- remember, we are all trying to make sense of this.

Newspapers, schools, community organizations, neighborhood institutions, local leaders, and residents can play an important role in reminding everyone that most reactions we are having to trauma and an uncertain world are well founded.

3. Promote Safety for All

While a range of feelings and reactions is to be expected, reactions of hate and violence against innocent people are not acceptable. The increase in discrimination, hate threats, and hate violence is unfair and unjust. The reports to date have been correctly described as a second wave of terrorism.

To ensure racism does not find its place in your community, educate yourself, your friends, your family members, and others about the diversity within your community and interact with this diversity. Converse with community members about their beliefs and traditions. Support small businesses and attend local community-building events (musical, sporting, artistic, awareness). Foster youth's tolerance, respect, and appreciation for diversity. Teach children tolerance and respect. Build personal, organizational, and political bridges and coalitions between different community groups and people. Stand up for each other. Post signs around your neighborhood in homes and local businesses. Speak up if you notice someone being harassed. Write letters opposing racist acts and discrimination to your local newspaper and call your local radio stations to voice your opinions.

The U.S. Commission on Civil Rights has established a hotline, 800-552-6843, for reports of hate crimes against Arab American, Muslim, and South Asian American victims of violent incidents. For more information on fighting hate and promoting tolerance, please visit http://www.tolerance.org. Global Exchange has a poster stating "Our Community is a Hate Free Zone." It carries a statement condemning anti-Arab and anti-Muslim violence. The poster is available at http://www.globalexchange.org/september11/hateFreeZone.html.

4. Stay Physically Active

During periods of intense emotion, it helps to get your blood flowing through movement. This is a great way to de-stress and de-compress. Exercise relaxes tense muscles and helps you sleep. More intensive physical activity that raises your heart rate triggers the release of endorphins into your blood stream. Endorphins can help you feel a greater sense of happiness and well being.

There's no need to spend an hour at the gym. Take a brisk walk around the block, around the yard, or even around the house. Go with a friend, a child, a dog, or just enjoy a few quiet minutes to yourself. Take the stairs instead of the elevator. Walk to the market instead of driving. Spend an evening dancing to your favorite music. Physical activity is especially crucial now, given the increased amount of time spent watching television. Exercise should be fun -- if you do not enjoy it, then you will probably not keep doing it.

Neighborhoods and communities can support physical activity by ensuring that there are safe and pleasant places for these activities to take place. Neighborhoods may want to organize weekend events that bring together residents of all ages to interact and enjoy physical activity. Schools can support teachers to include physical activity in the school day by providing equipment, adequate facilities, or trained staff. Teachers can encourage students to take stretch breaks and organize active games during recess or other breaks. Workplaces can encourage employees to take time during lunch or regular breaks to walk around the block or stretch and can provide benefits that include full or partial reimbursement for gym memberships, exercise or yoga classes, or children's sports leagues.

5. Beware of TV

Many of us rely on television for information. In fact, television is a primary source of news for most of us and has proved vital as an information source during these events. While we need access to information, keep in mind the impact this news and particularly the repeated images has on us, and especially on children. Many of us have witnessed a bombardment of violent and frightening images since the terrorist attacks took place. For many of us, there is a cost -- compromised sleep, bad dreams, preoccupation, and fear. Be aware of your own responses and moderate your viewing accordingly.

While adults are having a hard time processing the events, it is even more difficult for children, particularly depending on their developmental level. Limit your young child's exposure to the media and graphic images. Instead of spending time together watching the news, substitute other forms of interaction. And while there has been a lot of attention and advice about young children, older children need support and reassurance as well. If you allow your child to watch the coverage of the terrorist attacks and the U.S. response, be prepared to discuss it. Be ready to answer them on their own terms. Discuss the events and your child's reactions and help them understand your own reactions.

6. Eat Healthy Foods

Be good to your body. Eating a well-balanced diet helps keep emotions balanced and prevents illness. Eat at least five servings of fruits and vegetables every day. Include servings of other high-fiber foods such as whole grain breads and cereals, to help regulate digestion and ensure a slow, steady release of energy into the bloodstream. These foods also provide important nutrients to keep your immune system strong. Round out your meals with protein and calcium sources. Cooking can be relaxing and a creative outlet. Try not to always eat on the run. Take the time to sit down with family and friends at mealtime.

Be cautious about your consumption of sugar, caffeine, and alcohol. Binging on high-sugar foods can cause a quick increase of glucose (sugar) in the blood followed by an energy slump. Excessive caffeine consumption can also add to feelings of anxiety and interfere with sleep. In small amounts alcohol may help you relax. In larger amounts it may increase stress as it disrupts sleep (and causes hangovers).

For more information, go to http://www.usda.gov/cnpp and http://www.pcrm.org.

7. Help Strengthen the Local Food System

The recent crisis revealed to many of us the importance of a safe, accessible food supply. This reinforces the wisdom of the community food security movement that advocates for strengthening the local food system to ensure all residents have access to nutritious food at all times. There are a variety of strategies that increase access to locally grown and processed foods. These include supporting community gardens, urban agriculture, sustainable smaller-scale farms and food processors and developing a strong distribution network that includes traditional stores and alternative retail outlets such as farmers' markets and subscription food boxes.

The benefits from these strategies are multifaceted. Gardening not only provides a source of food -- it is therapeutic and a good form of physical activity. Participating in community gardens can build stronger ties among neighborhood residents. Buying foodstuffs directly from local farmers and food processors can stimulate the local economy, reduce fuel use (since goods are not transported long distances), and provide an extremely fresh, better-tasting food source. Selecting products grown without the heavy use of synthetic fertilizers, pesticides and herbicides helps preserve the environment and reduces the exposure of farmers, farm workers, and residents to toxic substances; it also reduces the overall reliance of farming on petroleum products.

For more information, go to http://www.foodsecurity.org.

8. Get Involved

Some people look at the devastation and grief following the terrorist attacks and want to help. Others are faced with the unknown and want to add meaning to their lives. Either way, many of us are looking for ways to help, ways to contribute, ways to find meaning. As we all pick up the pieces, we want to be involved in a substantive way. We are asking, what can I do? Fortunately, there are a lot of possibilities.

As we have seen, people can contribute by donating blood and supplies to victims, by providing financial support to aid organizations, and by offering special skills such as construction, mental health, medical, organizing, and rescue. While these are largely being offered to victims, there are a number of things we can all do within in our own communities that will assist our neighbors, strengthen the places we live in, create connections with others, and meet our own needs to find meaning. Find a place or a cause you feel good about and get involved. For example, work with youth, visit with the elderly, clean up the neighborhood, volunteer with community organizations, hospitals, or schools, or organize community events.

Communities can support involvement by ensuring that members know about needs and possibilities. This may include creating community service programs, training adults to mentor youth, developing community gardens, fostering youth leadership programs, and developing apprenticeships and internships for young people in partnership with the local business community.

9. Prevent Violence in Your Community

Violence is a learned behavior. The violent acts on September 11 and the subsequent responses have increased the degree of violence in our society. While we already lived in a society with unacceptably high levels of violence, our exposure to violence and societal acceptance of it has changed. Through media images and words, the political response to the attacks, and reaction among Americans, violence seems more acceptable in our society than ever. This is reflected in the fears of our youth, a sense of not being safe, and in the increase in hate crimes and threats. Individual violent acts now appear less significant as our tolerance for violence has increased. But we cannot become desensitized to violence and accept it as normal.

Many people and communities have been engaged in violence prevention activities for years. We have tools and models to think through effective strategies. Each of us can reject violence as normal and inevitable. We can reflect on the roots of violence and peace on an individual and national level and on our individual and national value system. We can think critically and consciously, analyzing our surroundings, current events, what we see on television, and what we encounter in our daily lives. We can develop comprehensive, community-based solutions that involve as many members as possible.

For more information about effective violence prevention, go to http://preventioninstitute.org.

10. Foster Creativity

The arts serve as one positive way of dealing with the diversity of emotions and issues arising for people. The visual and creative arts enable people of all ages to appropriately express their emotions and to experience risk-taking in a safe environment. For those who have witnessed violence, as we all recently have, art can serve as a healing mechanism. It provides a medium for expressing emotions, which is key to beginning the healing process, and promotes social interaction. More broadly, art can mobilize a community while reflecting and validating its cultural values and beliefs, including those about violence.

Participate in art and creative opportunities when possible. Attend concerts, create music, participate in cooking workshops, take part in a poetry slam, paint a picture, sculpture clay, create a collage, act in a play, write a poem or short story, dance, organize and design a community mural. Encourage children to draw, paint, and play with clay as a way to express themselves. Communities can increase access to creative opportunities by arranging workshops and providing facilities in which artistic expression can take place. Community plays can be cooperatively written and performed, reflecting shared values and giving members an opportunity to express themselves.

For more information on the arts, please visit http://www.artsusa.org.

11. Speak Up

Individuals and communities have important voices to be heard as we explore how to move on from here. Currently, the federal government is making substantive decisions with long-term implications. Some agree with the current course of action, others do not. As members of a democracy, everyone has a voice. Speak up and be heard -- you have a voice. Contact your representatives and let them know what you think. Vote in local elections. Support local politicians and policies that endorse your views. Write to newspapers. Make sure your voice is heard in as many arenas as possible.

Individual voices have more weight when they are part of a community voice. Communities can organize opportunities for their members to express their voice, values, and priorities. Only when community members come together will they be successful in ensuring safety, supporting sustainable development and transportation, and improving education.

12. Increase Transportation Opportunities

The terrorist attacks greatly affected the nation's transportation system and compromised many people's ability to get where they needed to be. The combination of a perceived threat and the halting of the air transportation system forced us to find alternative means of transportation. While airlines have resumed service, their grounding demonstrated our limited options. Within New York and Washington D.C., even local transportation systems became compromised. The attacks have highlighted how our transportation systems can be improved; people are thinking about transportation, reinforcing and perhaps making more realizable the notion that more diverse transportation systems are essential. In the long term, a reliable range of transportation choices is important for all of us. More diverse transportation systems can promote rapid mobility, address environmental concerns, reduce traffic injuries, and reduce an overall reliance on petroleum products. One option is the development of high-speed, long-distance rail systems between urban centers and along urban corridors. Walking and bicycling makes our communities more livable. These activities can be encouraged through community design.

For more information, go to http://www.transact.org or http://www.lgc.org.

13. Get a Global Perspective

The American psyche, which sees its relatively peaceful surroundings as a birthright, has experienced terrorism firsthand. This was a despicable act. While there are no explanations that could ever satisfy, it is important to recognize that this was carried out in a larger context. This involves the US, its culture, values, history, and foreign policy choices in relation to people and countries in other parts of the world. Understanding this context can help inform our reactions and decisions. As more of us understand our own foreign policies and the perspectives of those in other parts of the world, we can ensure that as a nation, we act with honor, justice, respect, and cultural appropriateness as global partners with other nations of the world. Also, while we cannot accept this act, we can understand how other nations and peoples view us and work to address some of the root factors that contributed to this horrible tragedy. In the long term, understanding other parts of the world will prevent more hatred garnered from misunderstandings.

Conclusion: What We've Learned from Prevention

We have been working on prevention issues for years. We know that the problems that plague individuals and communities -- violence, traffic crashes, HIV/AIDS, chronic disease -- are too complex to solve with simple solutions. We also know that no epidemic has ever been eliminated by treatment of the individual. In fact, we need a much broader, multifaceted approach. Too many people have been affected by the terrorist attacks to address the fallout one person at a time. Instead, we must think about improving neighborhoods, schools, and workplaces to support people's ability to cope and flourish.

This fundamental approach to prevention -- moving beyond risk to focusing on resiliency factors -- can be hard. Prevention is often overlooked or misunderstood, particularly during times of extreme threat when people can feel like there is no point to a long-term outlook. But the choices we make now will impact how we handle the immediate situation and how we fare in the long term. In fact, there are things we can all do now that will: 1) improve our ability to cope with the current situation, 2) strengthen our own long-term health, and 3) strengthen our families and our communities for now and into the future.

Sept. 11 Resources

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